Background Although multiple clinical trials have established the efficacy of mechanical thrombectomy (MT) in managing acute ischemic stroke (AIS) in the general population, its outcomes specifically in elderly patients remain uncertain. This study aims to evaluate the efficacy and safety of MT in elderly patients with AIS, providing a clearer understanding of its potential benefits in this population. Methods We searched PubMed, Embase, and Cochrane databases for randomized clinical trials (RCTs) comparing MT with standard medical management in patients with AIS, with data available for elderly patients (over 70 years). Outcomes included functional recovery (≥1-point mRS improvement), excellent (mRS 0–2), good (mRS 0–3), poor (mRS ≥5) outcomes, and mortality at 90 days. Pooled odds and risk ratios (OR and RR) with 95% confidence intervals (CIs) were estimated using a random-effects model. Results Fifteen RCTs, involving 1481 elderly patients, were included. MT was associated with a better functional recovery (OR 1.54; 95% CI: 1.22–1.94; P 80 years), anterior/posterior circulation, and country socioeconomic status were consistent with the overall results. Conclusions This updated meta-analysis suggests that MT may be associated with better functional outcomes and lower mortality in selected elderly patients with AIS; however, limited elderly specific safety data and selective trial populations warrant cautious interpretation.
Cardoso et al. (2026) studied this question.