The outcomes of mechanical thrombectomy in nonagenarians and octogenarians in a majority hispanic population

Background/objective: Elderly patients (≥ 80 years) were underrepresented in randomized trials that proved the efficacy and safety of mechanical thrombectomy (MT) in acute ischemic strokes (AIS) due to large vessel occlusion (LVO). Additionally, the impact of race and socioeconomics on AIS outcomes is well-reported. We sought to compare the MT clinical outcomes between octogenarians and nonagenarians, the majority of whom are Hispanic, in underserved border communities.

Methods: This is a retrospective cohort study that was conducted in a comprehensive stroke center between 2012 and 2020. The baseline characteristics and outcomes were compared between the two groups. The primary measured outcome included a favorable outcome on the modified Rankin Scale (mRS) after three months (mRS ≤ 2). Secondary outcomes included mortality, symptomatic intracerebral hemorrhage (sICH), and an improvement in NIH Stroke Scale (NIHSS) score (≤4).

Results: Of 215 included patients, 184 (85.6%) were octogenarians and 31 (14.4%) were nonagenarians. There were no significant differences between octogenarians and nonagenarians in terms of rates of favorable outcomes after three months (30.4% vs. 19.4%, p = 0.247), clinical improvement in discharge NIHSS (16.3% vs. 19.4%, p = 0.753), mortality (24.5% vs. 29.0%; p = 0.710) and sICH (6.5% vs. 3.2%, p = 0.780). Furthermore, Hispanic and non-Hispanic patients had similar outcomes.

Conclusion: There were no significant differences in the outcomes of MT between octogenarians and nonagenarians and between Hispanic and non-Hispanic patients. The similar clinical outcomes between both age groups in our study and the lower rates of sICH support the use of this treatment among people who are aged 80 or older.