Long-term functional outcomes for elderly patients treated with endovascular thrombectomy.

Abstract

BackgroundFunctional outcomes in elderly thrombectomy patients have been commonly reported up to 90 days, though long-term neurological status is not as well characterized. We studied 1-year outcomes in patients ≥ 80 years old and identified predictors of functional independence in elderly patients.MethodsRetrospective analysis of anterior circulation thrombectomy patients presenting from November 2016-August 2023 to a large health system. The primary outcome was 1-year modified Rankin Scale score (mRS) 0-2. Outcomes were compared between patients ≥ 80 and < 80 years old. Logistic regression was performed to identify predictors of 1-year functional independence in the elderly.Results957 patients were included, 220 (23%) of whom were ≥ 80 years old. A significantly lower proportion of patients ≥ 80 years old, compared to < 80 years, were functionally independent at 1-year (18.6% versus 45.9%, p < 0.001). In the elderly, predictors of functional independence included age (odds ratio (OR) 0.83, 95% confidence interval (CI) 0.74-0.93, p = 0.002), premorbid mRS score (OR 0.51, 95% CI 0.29-0.88, p = 0.016), presenting National Institutes of Health Stroke Scale score (OR 0.93, 95% CI 0.87-0.995, p = 0.035), cerebral blood volume index (OR 50.7, 95% CI 2.8-935, p = 0.008), and first-pass recanalization (OR 2.77, 95% CI 1.20-6.38, p = 0.017).ConclusionElderly thrombectomy patients had lower rates of functional independence at 1-year, though these are similar to previously reported rates at 90-days in octogenarians and nonagenarians. Factors associated with good outcomes in the elderly, including collateral status and single-pass revascularization, may be prognostically informative beyond the 90-day time window.