Background: There is controversy whether the benefit of endovascular treatment is applicable to acute ischemic stroke patients who are aged >85 years.
Objective: To determine the effects of endovascular treatment on clinical and safety outcomes compared with best medical treatment in trials that permitted recruitment of patients aged>85 years. .
Methods: Four randomized trials that compared endovascular treatment with best medical treatment in acute ischemic stroke patients met the inclusion criteria. We calculated pooled odds ratios and 95% CIs (confidence intervals) using random-effects models. The primary endpoint was a favorable outcome defined by a modified Rankin scale grade of 0 (no symptoms), 1 (no significant disability), or 2 (slight disability) at 90 days post-randomization.
Results: Of the 1012 total subjects randomized, the proportion of subjects who achieved a favorable outcome was significantly greater among those randomized to endovascular treatment compared with best medical treatment (1012 subjects analyzed, odds ratio 2.37, 95% CI 1.81-3.13, p< .001). Excellent outcome (modified Rankin scale grade of 0 or 1) was also significantly greater among those randomized to endovascular treatment (881 subjects analyzed, odds ratio 2.47, 95% CI 1.69-3.61, p< .001). Risk of symptomatic intracranial hemorrhage was similar between endovascular treatment and medical treatment (1012 subjects analyzed, odds ratio 1.33, 95% CI 0.73-2.26; p= 0.38). In two trials that provided a comparison of odds of favorable outcome between patients aged ≥ 80 years and < 80 years, the odds for favorable outcome were higher in patients aged <80 years ( 811 subjects analyzed, odds ratio 2.32, 95%CI 1.71-3.16, p< .001 ).
Conclusions: Compared with best medical treatment, the odds of achieving a favorable outcome or excellent outcome at 3 months post-randomization is approximately 2 folds higher with endovascular treatment among patients including those aged > 85 years with acute ischemic stroke