Do people in their 80s and 90s have different outcomes after endovascular stroke treatment than younger patients?

Details

Endovascular therapy for emergent large vessel occlusion is an established standard approach for acute ischaemic stroke. However, its effectiveness and safety in very elderly patients had not been proved. This study aimed to assess its safety and effectiveness in people in their 80s and 90s.

Researchers retrospectively reviewed all patients who underwent endovascular therapy at two stroke centres between April 2012 and July 2018. They compared younger patients aged 46–79 years (n = 40) with patients aged 80–97 years (n = 19).

Functional outcome was assessed using the modified Rankin scale at 90 days after stroke or at discharge. A favourable outcome meant a modified Rankin scale score of 0–2, or no worsening from the patient's pre-stroke score.

Pre-stroke functional deficits, defined as a modified Rankin scale score >1, were more frequent in the older group than in the younger group: 57.9% versus 20.0% (P = 0.0059).

No statistically significant differences were observed between the older and younger groups in successful reperfusion (89.5% versus 67.5%, P = 0.11), favourable functional outcome (47.4% versus 45.0%, P = 1.00), or mortality (21.1% versus 27.5%, P = 1.00).

In multiple regression analysis, successful reperfusion, concomitant use of intravenous thrombolysis, and stroke onset outside hospital were independent predictors of a favourable outcome (P = 0.0003, 0.015 and 0.028, respectively).

The authors concluded that successful reperfusion, concomitant intravenous thrombolysis and out-of-hospital onset were clinical predictors of a favourable outcome. They did not observe an age-dependent effect on clinical outcome after endovascular therapy.