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Background: Elderly patients account for 30% of acute ischemic stroke (AIS) but are under-represented in randomized controlled trials of endovascular thrombectomy (EVT). To date, meta-analysis of “real world” observational studies focusing on 90-day outcomes between patients ≥80 and <80 years have been limited to small numbers undergoing EVT with older generation devices. Methods: The present study is a retrospective analysis of a prospectively collected patient cohort who received EVT for anterior cerebral circulation AIS at an Australian centre over 2.5-years. The study aims to determine (i) the proportion of good 90-day functional outcomes (modified Rankin Scale mRS 0-2) in patients ≥80 compared with <80 years (ii) prognostic factors influencing 90-day outcome in patients ≥80 years and (iii) a comparison of our data to those previously reported in the literature using a meta-analysis of outcomes and mortality in observational studies using second generation stent retrievers. Results: We analyzed 2387 patients (≥80 years, n=649; <80 years, n=1738) from 14 studies including our study (≥80 years, n=71; <80 years, n=110). 28% of our elderly cohort and 30% of the pooled meta-analysis cohort achieved good 90-day functional outcomes compared to 55% and 52%, respectively of younger patients. 27% of our elderly cohort and 26% of the meta-analysis elderly cohort died compared to 16% and 15%, respectively of younger patients. Higher baseline NIHSS correlated with poor prognosis in the elderly. Conclusion: EVT has less favorable outcomes in elderly patients. However, results are better than historical AIS outcomes providing further support for EVT in the elderly.
Sharobeam et al. (Wed,) studied this question.