Abstract WP063: A shorter procedure time of less than 60 minutes in endovascular thrombectomy may lead to the good outcomes in elderly acute stroke patients.

Background: It is well known that in endovascular thrombectomy (ET), the shorter procedure time (PT) from puncture to recanalization is associated with better outcomes. As the number of independent elderly people is increasing, the demand for ET is growing. However, data on PT in elderly patients are limited. Therefore we investigated the relationship between PT and outcomes in elderly patients using data from the multicenter stroke registry (HARP) in Hiroshima, Japan. Methods: We retrospectively studied acute ischemic stroke cases, especially in elderly people aged ≥80 years with pre-stroke mRS ≤3, who underwent ET from July 2020 to December 2024 and achieved successful recanalization (TICI ≥2b). We divided patients into two groups: the “early group” assigned in which PT was less than 60 minutes, the “delayed group” in which PT was 60 minutes or more. Univariate analysis was performed to assess the associations between PT and outcomes, including mRS at discharge and 90 days, mortality, and complications. Since the target patients had mRS ≤3, a “good outcome” was defined as mRS ≤2 or mRS ≤3 for patients with pre-stroke mRS 3. Results: 288 eligible patients (median age 86 years; 36.8% male) were included. 178 patients were assigned to the early group (median PT 35 minutes) and 110 patients to the delayed group (median PT 78 minutes). Baseline characteristics, including age (86 vs. 85 years, p=0.286), onset-to-puncture time (224 vs. 242 minutes, p=0.353), ASPECTS (8 vs. 8, p=0.738), and NIHSS (18 vs. 20, p=0.618), were comparable between groups. No significant difference was observed in symptomatic intracranial hemorrhage between the two groups (5.6% vs. 8.2%, p=0.394). Cardioembolic stroke was more common in the early group (82.0% vs. 68.2%, p=0.007), whereas internal carotid artery occlusion was more frequent in the delayed group (25.3% vs. 40.0, p=0.009). The delayed group also required more ET attempts (1 vs. 2, p<0.001) and PTA (1.7% vs 11.1%, p<0.001). Good outcomes were more frequent in the early group than in the delayed group at discharge (24.7% vs. 14.5%, p=0.039) and at 90 days (34.6% vs. 19.2%, p=0.008). Mortality at discharge was not significantly different (7.3% vs. 12.7%, p=0.125). Conclusion: In elderly patients, PT <60 minutes was associated with better outcomes. These results were similar to past reports for all adults. These findings highlight the importance of shortening PT and considering pre-stroke function in treatment decisions.