Outcomes of Endovascular Thrombectomy for Acute Ischaemic Stroke in Patients Aged ≥80 Years: A Hong Kong Stroke Center Experience

Background: Elderly patients contribute to the large proportion of ischaemic stroke worldwide. Currently, treatment for elderly stroke remains aggressive, as the exact age cutoff for endovascular thrombectomy (EVT) has not been well established due to a lack of large-scale randomized control trials. In this study we investigate the difference in outcome after EVT in the octogenarian and above, compared to their younger counterparts.

Methods: EVT patients were divided into two groups, the octogenarian group and younger group (below age of 80). Primary outcome were the 90-days post-thrombectomy functional independence (modified Rankin scale), and Barthel index. Secondary and safety outcomes of post-thrombectomy were also analyzed, including reperfusion status (modified Thrombolysis in Cerebral Infarction (TICI) score), National Institutes of Health Stroke Scale (NIHSS), major complications and mortality rate.

Results: A total 340 patients were included from 2020 to 29 Feb 2024, and patients' demographics were obtained. Poorer neurological outcome and functional independence were noted in octogenarian group compared with younger counterpart (OR 0.33; 95% CI 0.14-0.51; p <0.001). A slightly higher trend of overall post-procedural death was also identified in elder group compared with the younger group [OR 1.48 (0.85-2.60), p =0.08]. Subgroup analysis with more advanced age cutoff at 90 took a step further and proposed that advanced age resulting in more devastating neurological outcome.

Conclusion: Outcomes after endovascular thrombectomy in the elder group were significantly worse than their younger counterparts. More than 80% of elder group who were treated with EVT required moderate functional dependence, and one in four were dead within 90-days post-EVT.