Age and Functional Outcomes in Patients With Large Ischemic Stroke Receiving Endovascular Thrombectomy
Authors: Winkelmeier Laurens , Kniep Helge , Faizy Tobias , Heitkamp Christian , Holtz Ludovic , Meyer Lukas , Flottmann Fabian , Heitkamp Alexander , Schell Maximilian , Thomalla Götz , Fiehler Jens , Broocks Gabriel ,   German Stroke Registry–Endovascular Treatment (GSR-ET), Allegiani Anna , Berrouschot Jörg , Boeckh-Behrens Tobias , Bohner Georg , Borggrefe Jan , Bormann Albrecht , Braun Michael , Dorn Franziska , Eckert Bernd , Ernemann Ulrike , Ernst Marielle , Fiehler Jens , Gerloff Christian , Gröschel Klaus , Hamann Gerhard F. , Hattingen Jörg , Henn Karl-Heinz , Keil Fee , Kellert Lars , Kraemer Christoffer , Mühl-Benninghaus Ruben , Liman Jan , Ludolf Alexander , Nolte Christian , Nikoubashman Omid , Petersen Martina , Petzold Gabor , Poli Sven , Reich Arno , Riedel Christian , Röther Joachim , Schäfer Jan Hendrik , Schell Maximilian , Schellinger Peter , Siebert Eberhard , Stögbauer Florian , Thomalla Götz , Tiedt Steffen , Trumm Christoph , Uphaus Timo , Wunderlich Silke , Zweynert Sarah 
Published: August 2024

Importance

Randomized clinical trials have demonstrated the efficacy and safety of endovascular thrombectomy for acute ischemic stroke with large infarct. Patients older than 80 years with large infarct are commonly encountered in clinical practice but underrepresented in randomized clinical trials.

Objective

To provide an age-based analysis of functional outcomes in endovascular thrombectomy for acute ischemic strokes with large infarct.

Design, Setting, and Participants

This retrospective multicenter cohort study included patients from the German Stroke Registry who received endovascular thrombectomy for acute ischemic stroke with large infarct at 1 of 25 German stroke centers between May 2015 and December 2021. Patients with acute ischemic stroke due to anterior circulation large vessel occlusion and large infarct were included. Large infarct was defined as an Alberta Stroke Program Early Computed Tomography Score of 0 to 5. Patients were subdivided by age to evaluate its association with functional outcomes.

Exposure

Age.

Main Outcomes and Measures

Primary outcomes were independent ambulation (90-day modified Rankin Scale score of 0-3) and mortality (90-day modified Rankin Scale score of 6).

Results

A total of 408 patients with large infarct were included (217 women [53.2%]; median [IQR] age, 75 [64-83] years). The rate of independent ambulation decreased from 56.4% in patients aged 60 years and younger (44 of 78 patients) to 15.1% in patients older than 80 years (19 of 126 patients) (P &amp;lt; .001), while mortality increased from 15.4% (12 patients) to 64.3% (81 patients) (P &amp;lt; .001). Being older than 80 years was associated with lower rates of independent ambulation (adjusted odds ratio [aOR], 0.44; 95% CI, 0.23-0.82; P = .01) and higher mortality (aOR, 2.75; 95% CI, 1.61-4.72; P &amp;lt; .001). A final modified Thrombolysis in Cerebral Infarction grade of 2b or 3 was associated with higher rates of independent ambulation (aOR, 4.95; 95% CI, 2.14-11.43; P &amp;lt; .001), independent of age and without significant interaction (aOR, 0.69; 95% CI, 0.35-1.34; P = .27).

Conclusions and Relevance

In this cohort study of patients with acute ischemic stroke and large infarct, age was associated with functional outcomes. Patients older than 80 years had poor prognosis with high mortality but with sizeable differences depending on additional baseline and treatment characteristics. While it does not seem justified to apply a fixed upper age limit for endovascular thrombectomy, these results could assist clinicians in making informed treatment decisions in older patients with large ischemic stroke.