Abstract P525: Endovascular Thrombectomy Outcomes in Transferred Octogenarians: A Multicenter Pooled Analysis

Abstract

Background: Acute ischemic strokes outcomes may be less favorable in elderly patients. Whether transferring octogenarians with large vessel occlusion (LVO) for endovascular thrombectomy (EVT) results in similar outcomes to younger patients is uncertain. Methods: A pooled cohort from 6 centers (Europe, US) from 1/2014 to 5/2020 of pts with (ICA, M1, M2) LVO transferred for EVT ≤ 24 hrs from LKW. Patients were stratified into < 80 vs ≥ 80 years old. We compared 90 day functional independence and safety outcomes and assessed for predictors of good outcome (mRS 0-2) and profound disability (mRS 5-6). Results: Of 1176 pts received EVT as transfers, 216 (18%) were octogenarians. Baseline NIHSS was higher in octogenarians [19 (14, 22) vs 17 (12, 21), p<0.001], while IV tPA (52% vs 54%, p=0.52) and time LKW to EVT center [285 (193, 537) vs 272 (190, 470) min, p=0.15] were similar. Functional independence rates were lower in patients ≥ 80 as compared to < 80 (26% vs 46%, aOR 0.50, 95%CI 0.34-0.75, p=0.001). sICH was similar (8.6 vs 9.9%, p=0.56), but octogenarians had significantly higher 90-day mortality (42% vs 17%, p<0.001). Milder strokes (aOR 0.88, 95%CI 0.86-0.91, p<0.001), earlier presentation (aOR 0.95, 95%CI 0.91-0.98, p=0.004) and IV tPA (aOR 1.34, 95%CI 0.98-1.84, p=0.069) were associated with higher functional independence odds after EVT in octogenarians. Higher stroke severity (12% for each point, aOR=1.12, 95%CI 1.11-1.17-, p<0.001) and delayed reperfusion (3% for each additional hr, aOR 1.03, 95%CI 1.00-1.06, p=0.071) were associated with profound disability following EVT in octogenarians. Conclusion: EVT may be associated with lower independence rates in transferred octogenarians with LVO. Milder stroke severity, earlier presentation and IV thrombolysis increased the odds of good outcomes in octogenarians. Severe strokes and later treatment were associated with profound disability. Optimized selection and workflow is warranted in transferring elderly patients for EVT.