Safety and Efficacy of Mechanical Thrombectomy in Elderly Patients with Acute Ischemic Stroke: A Single-Center Experience

Abstract

Background Mechanical thrombectomy (MT) has been established as the first-line treatment for acute ischemic stroke (AIS) from large vessel occlusions. However, the benefits of MT to the patients over 80 years old is not yet clear, for the elderly with AIS were usually excluded from large randomized controlled stroke clinical trials for their poor prognosis. Methods This study enrolled 187 adult patients with acute ischemic stroke from large vessel occlusions, including 53 patients ≥ 80 years old. Propensity score matching was used to match the patients༜80 years old with those ≥ 80 years old in a ratio of 1:1. The elderly patients were divided into bridging therapy subgroup and direct MT subgroup. The baseline characteristics and outcome were compared between younger patients and older patients, and elderly patients in two subgroups by multivariate logistic regression analysis. Results The good functional status at 90 days occurred in 44 (32.8%) younger patients, 12 (22.6%) in older patients, but the difference was not statistically significant (adjusted OR, 1.244[95%CI,0.520–2.882], P = 0.644). A higher mortality rate was observed in older patients (43% vs 16%, OR,0.245[95%CI,0.104–0.578], P = 0.001). After propensity score matching, the similar results were found in the good functional prognosis and mortality in the two groups. Moreover, in elderly patients, no significant difference was found in the outcome between the two subgroups. Conclusions Elderly patients with AIS from large vessel occlusions who received MT had similar good functional status and successful reperfusion to patients༜80 years old. MT is effective and relatively safe for the elderly.