Abstract Number: Esoc2026a926 Mechanical Thrombectomy in Nonagenarians: Outcomes Comparable to Younger Patients After Multidisciplinary Selection

Abstract Background and aims Mechanical thrombectomy (MT) is the standard treatment for ischemic stroke due to large vessel occlusion. Although advanced age is associated with poorer outcomes, age alone should not contraindicate endovascular therapy. Data on patients aged ≥90 years remain scarce in clinical practice. Methods We conducted a retrospective, single-center cohort study of consecutive patients treated with MT. Fifty patients aged ≥90 years were compared with 100 younger patients. In nonagenarians, eligibility for MT was determined individually by a multidisciplinary stroke team. Baseline characteristics, procedural variables, and outcomes were analyzed. Inverse probability weighting (IPW) was used to adjust for baseline imbalances. Primary outcomes were functional independence at 90 days (modified Rankin Scale mRS 0–2) and 90-day mortality. Secondary outcomes included successful reperfusion (TICI 2b–3), neurological status at discharge, and hemorrhagic complications. Results Nonagenarians had worse baseline characteristics. Successful reperfusion (TICI 2b–3) was similar in patients aged ≥90 years and younger patients (92.0% vs 89.0%). Functional independence at 90 days occurred in 18.0% versus 49.0%, respectively, but the difference was no longer significant after IPW adjustment (risk difference −0.10, 95% CI −0.29 to 0.09). Ninety-day mortality was higher in unadjusted analyses (48.0% vs 20.0%), but not after IPW-weighted analysis. Parenchymal hemorrhage was more frequent in nonagenarians (28.0% vs 10.0%), while symptomatic intracerebral hemorrhage rates were similar. Conclusions After adjustment for baseline differences, carefully selected nonagenarians achieved outcomes comparable to younger patients undergoing MT, despite a higher risk of parenchymal hemorrhage. These findings support individualized, multidisciplinary patient selection rather than age-based exclusion from thrombectomy. Conflict of interest Bartosz Jabłoński: nothing to disclose. Aleksandra Pracoń: nothing to disclose. Adam Wyszomirski: nothing to disclose. Anna Gwiazda: nothing to disclose. Marcin Stańczak: nothing to disclose. Łukasz Maciołek: nothing to disclose. Dariusz Gąsecki: nothing to disclose. Edyta Szurowska: nothing to disclose. Bartosz Karaszewski: nothing to disclose. Table 1 - belongs to Results