Achieving complete recanalization is the best predicting factor of good outcome for thrombectomy in the elderly. Results from a prospective monocentric study.

Abstract

Background and aims: Little is known about predicting factors for a good outcome (GO) after endovascular treatment (EVT) performed for acute ischemic stroke (AIS) related to large vessel occlusion (LVO) in the over-80s population. We evaluate demographic and procedural predictors of GO from our prospective registry of patients treated during the acute phase of an LVO-related AIS.

Methods: GO was defined as a 3-month modified Rankin scale (mRS) [Formula: see text] 3 or equivalent to pre-stroke mRS. Univariate (UVA) and multivariate (MVA) analysis were performed to assess the factors' independent effect on the outcome. The magnitude of the between-group differences was assessed by calculating the standardized differences (StD). Variables with StD >0,2 were included in the MVA.

Results: From 182 patients aged ≥ 80, 3-month GO was observed in 31.3% (57/182). The proportion of TICI ≥ 2c-3 was significantly lower in the poor outcome (PO) group compared to the GO group (52% versus 78.9%, StD = 0.591). In univariate logistic regression model, TICI ≥ 2c-3 is associated with a 277% increase in the chances of a GO (OR = 3.77, 95%CI 1.79-7.97, P < 0.001). This association remained significant in multivariate logistic regression model (aOR = 0.77, 95%CI 0.66-0.89, P = 0.000501) even when a hemorrhagic transformation (HT) occurs (p het = 0.57948).

Conclusions: We show that achieving a TICI score of 2c-3 seems to be the best predictive factor for the outcome in the elderly population. In this group, every effort should be made to achieve excellent recanalization.