Endovascular Treatment for Patients Aged ≥80 Years with Large Ischemic Stroke

Abstract

Objectives Whether endovascular treatment (EVT) remained effective and safe in patients aged ≥80 years with large ischemic stroke was unclear. We aimed to investigate the effectiveness and safety of EVT in this population. Materials and Methods Using data from a cohort study and randomized controlled trial, we included patients aged ≥80 years with large ischemic stroke treated with EVT or standard medical treatment (SMT) alone, and compared clinical outcomes between the two groups. Furthermore, EVT patients were dichotomized by age (80–84 and ≥85 years) to evaluate associations between age and outcomes. The primary effectiveness outcome was the distribution of 90-day modified Rankin scale (mRS) score. Safety outcomes were 90-day mortality and symptomatic intracerebral hemorrhage within 48 hours. Results 270 eligible patients were included, with 212 in EVT group. EVT was associated with a favorable shift in the distribution of 90-day mRS scores compared with SMT (adjusted common odds ratio 2.83, 95% confidence interval 1.48–5.70, P=0.003). Secondary effectiveness outcomes including 90-day mRS score 0–2, 0–3 and 0–4 also favored EVT. The 90-day mortality was significantly lower in EVT group (P=0.009). However, the rate of any intracerebral hemorrhage was significantly higher in EVT group (P=0.001). Notably, increasing age did not modify the treatment effect of EVT. Conclusions Among patients aged ≥80 years with large ischemic stroke, EVT was associated with more favorable 90-day functional outcomes and lower mortality than SMT, but with a higher risk of intracerebral hemorrhage. The treatment effect of EVT remained consistent regardless of age in this population.