Effectiveness of endovascular thrombectomy in patients over 80 years of age

Objective: Endovascular thrombectomy (EVT), with or without intravenous thrombolysis, has become the standard treatment for acute ischemic stroke, especially in large vessel occlusions. This study provides valuable insights about the effectiveness of EVT in these patients. Methods: We retrospectively reviewed patients who underwent EVT for acute ischemic stroke at age 80 or over between 2014 and 2022. Procedural and functional outcomes were assessed with the thrombolysis in cerebral infarction (TICI) score and National Institutes of Health Stroke Scale (NIHSS) after EVT, in comparison with the initial NIHSS. We divided patients into the improved NIHSS group, the non-improved group, and the expired group. Results: Eighty patients who underwent EVT from 2014 to 2022 were analyzed. Fifty-seven patients improved, whereas 23 patients did not improve or expired after EVT. Successful recanalization (TICI IIb or III) was reported in 88.7% of cases. The locations of occlusion differed among the groups. The most frequently discovered location of occlusion was sphenoidal segment of middle cerebral artery (M1), and occlusions were most frequently discovered in the internal carotid artery in the group without NIHSS improvements. Conclusion: This study revealed that EVT in elderly patients was effective, and occlusion of a distal vessel could be a good prognostic factor. Reducing puncture time was also identified as the most important factor in elderly patients. Lastly, if TICI IIb reperfusion is discovered during the procedure, additional reperfusion attempts should be avoided.