Endovascular thrombectomy in octogenarians and nonagenarians with large vessel occlusion: Technical aspects and clinical outcome

Background: Safety and efficacy of thrombectomy in patients ≥80-year-old is not fully understood as this age group is underrepresented in major clinical trials. Objectives: To review the procedural aspects and clinical outcome of thrombectomy among octogenarians and nonagenarians in a busy comprehensive stroke center. Methods: We retrospectively identified all patients ≥80-year-old who underwent thrombectomy for acute ischemic stroke with emergent large vessel occlusion (ELVO) in the anterior circulation in our institution. Demographics, procedural variables, anesthesia modality, and clinical outcome measures were extracted. The rates of successful recanalization (defined as TICI ≥ 2B), symptomatic hemorrhagic transformation and favorable clinical outcome (defined as mRS<3 at 90 days) were identified. Results: A total of 113 patients were identified. The median age for the cohort was 85 years (range: 80-103). Median admission NIHSS score was 18 (IQR: 14–25). Successful recanalization was achieved in 101 patients (89%). Monitored anesthesia care (MAC) was used in 78% of the patients. Groin puncture to recanalization time was shorter in patients under MAC (45±36 vs 120±50; p=0.006); however, no statistically significant difference in the rate of 90-day favorable outcome was observed between MAC and general anesthesia(23% vs 20%, p=0.77). From 72 patients with baseline mRS<3, 22% had a favorable 90-day outcome. Conclusion: Thrombectomy in octogenarians and nonagenarians is technically feasible and associated with high rate of recanalization. Anesthesia type was not a predictor of outcome and does not pose a threat on procedural time. Nearly one out of four patients in this study had a favorable clinical outcome.