Introduction: Mechanical thrombectomy (MT) for large vessels occlusion of anterior circulation acute ischemic stroke (AIS) improves functional outcome at 3-month. However, elderly patients (≥80 years old) are a growing and fragile population for whom data are scarce.
Hypothesis: To determine the factors associated with a favorable functional outcome after endovascular treatment for anterior circulation AIS in elderly patients.
Methods: All patients aged≥ 80 years old with anterior circulation AIS and a primary functional independence (mRS<2) referred for MT were included. Reperfusion success was defined as TICI2b/3. Functional outcome at 3-month (mRS), mortality, symptomatic intracranial hemorrhage (SIH), NIHSS at 24h and at discharge were collected. Initial NIHSS, gender, age, AIS and coronaropathy anteriority, glycemia and diabetes, hyperlipemia, hypertension, time to IV thrombolysis, time to groin puncture, successful recanalization, general anesthesia, DWI-ASPECTS, 24h intracranial hemorrhage, occlusion location and IV thrombolysis were evaluated as prognostic factors associated with a favorable functional outcome (mRS<2). Quantitative variables were evaluated using paired-sample Wilcoxon signed-rank test and qualitative variables were categorized as binary variables and compared using Chi-square test.
Results: A total of 82 patients were treated for anterior circulation AIS with a recanalization rate of 87%. The NIHSS score was improved from 16.7 ± 6 [range: 3-27], to 12.2 ± 8.2 [range: 0-32] at 24h, (p=0.0001) and 9.3 ± 7.77 [range: 0-32] at discharge (p=6 x 10-7). We found a SIH rate of 1% while 40% of patients had intracranial hemorrhage, mortality was 27%, and at 3 months 29% of patients were functionally independent (mRS ≤ 2) and 16% had moderate disability (mRS=3). DWI-ASPECTS (p=0.007), low initial NIHSS (p=0.013), age (p=0.02) and IV thrombolysis (p=0.03), were associated with a favorable functional outcome. Use of general anesthesia (p=0.09), diabetes (p=0.05) and hyperglycemia (p=0.05) were associated with a poorer outcome at a lesser degree.
Conclusions: MT of anterior circulation AIS in elderly patients is safe and effective.