Endovascular Treatment for Patients Aged ≥80 Years with Large Ischemic Stroke

Chawen Ding,1,* Linyu Li,1,2,* Gaoming Li,2,* Zhenqian Liu,1,* Lingyu Zhang,3 Haoxuan Zhu,2,4 Xu Xu,2 Jinfu Ma,2 Kaiyuan Feng,2 Chunye Chen,2 Jiaxing Song,1,2 Mingrui Zhou,5 Wenjie Zi1,21Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 2Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, People’s Republic of China; 3Department of Neurology, Lanzhou University Second Hospital, Lanzhou, Gansu, People’s Republic of China; 4Department of Neurology, The 908th Hospital of Chinese People’s Liberation Army Joint Logistic Support Force, Nanchang, Jiangxi, People’s Republic of China; 5The First Clinical Medical School, Hubei University of Chinese Medicine, Wuhan, Hubei, People’s Republic of China*These authors contributed equally to this workCorrespondence: Wenjie Zi, Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, No. 288, Tianwen Avenue, Chayuan, Nan’an District, Chongqing, 400010, People’s Republic of China, Tel +86 18523033816, Email ziwenjie@126.com; Mingrui Zhou, The First Clinical Medical School, Hubei University of Chinese Medicine, No. 16, Huangjiahuxi Road, Hongshan District, Wuhan, 430065, People’s Republic of China, Tel +86 15802725815, Email viperh1003@163.comObjectives: Whether endovascular treatment (EVT) remained effective and safe in patients aged ≥ 80 years with large ischemic stroke was unclear. We aimed to investigate the effectiveness and safety of EVT in this population.Materials and Methods: Using data from a cohort study and randomized controlled trial, we included patients aged ≥ 80 years with large ischemic stroke treated with EVT or standard medical treatment (SMT) alone, and compared clinical outcomes between the two groups. Furthermore, EVT patients were dichotomized by age (80– 84 and ≥ 85 years) to evaluate associations between age and outcomes. The primary effectiveness outcome was the distribution of 90-day modified Rankin scale (mRS) score. Safety outcomes were 90-day mortality and symptomatic intracerebral hemorrhage within 48 hours.Results: 270 eligible patients were included, with 212 in EVT group. EVT was associated with a favorable shift in the distribution of 90-day mRS scores compared with SMT (adjusted common odds ratio 2.83, 95% confidence interval 1.48– 5.70, P=0.003). Secondary effectiveness outcomes including 90-day mRS score 0– 2, 0– 3 and 0– 4 also favored EVT. The 90-day mortality was significantly lower in EVT group (P=0.009). However, the rate of any intracerebral hemorrhage was significantly higher in EVT group (P=0.001). Notably, increasing age did not modify the treatment effect of EVT.Conclusions: Among patients aged ≥ 80 years with large ischemic stroke, EVT was associated with more favorable 90-day functional outcomes and lower mortality than SMT, but with a higher risk of intracerebral hemorrhage. The treatment effect of EVT remained consistent regardless of age in this population.Keywords: large ischemic stroke, aged 80 and over, large vessel occlusion, endovascular treatment, clinical outcomes