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Endovascular thrombectomy for acute ischemic stroke in elderly patients with large ischemic cores

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Abstract

Background

Understanding the benefits and risks of endovascular therapy (EVT) is crucial for elderly patients with large ischemic cores, as the combination of advanced age and extensive brain infarction may negatively impact clinical outcomes.

Methods

The study retrospectively analyzed clinical outcomes for elderly stroke patients (age ≥ 70) with large ischemic cores (Alberta Stroke Program Early CT Score [ASPECTS] < 6 or ischemic cores ≥ 70 ml) in the anterior circulation using data from our prospective database between June 2018 and January 2022. The effectiveness and risks of EVT in those patients were investigated, with the primary outcome being fair outcome (modified Rankin Scale, mRS ≤ 3).

Results

Among 182 elderly patients with large ischemic core volume (120 in the EVT group and 62 in the non-EVT group), 20.9% (38/182, 22.5% in the EVT group vs. 17.7% in the non-EVT group) achieved a fair outcome. Meanwhile, 49.5% (90/182, 45.8% in the EVT group vs. 56.5% in the non-EVT group) of them died at 3 months. The benefits of EVT numerically exceeded non-EVT treatment for those aged ≤  ~ 85 years or with a mismatch volume ≥  ~ 50 ml. However, after adjustment, EVT was associated with an increased risk of symptomatic intracranial hemorrhage (aOR 4.24, 95%CI 1.262–14.247).

Conclusions

This study highlights the clinical challenges faced by elderly patients with large infarctions, resulting in poor outcomes at 3 months. EVT may still provide some benefits in this population, but it also carries an increased risk of intracranial hemorrhage.

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Data availability

All relevant data are available from the corresponding authors.

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Author notes

  1. Qian Liu and Jinghuan Fang have contributed equally to this work and share first authorship.

Authors and Affiliations

  1. Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, China

    Qian Liu, Jinghuan Fang, Xin Jiang, Yaxi Luo, Lijie Gao, Shuju Dong, Mengmeng Ma, Muke Zhou & Li He

  2. Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, China

    Ting Duan

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  1. Qian Liu
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Contributions

Q.L. and L.H. developed the initial idea for this study. Q.L., J.H.F., M.K.Z., and L.H. formulated the study design. L.H. and M.K.Z. were consulted about clinical issues. Q.L. contributed to the original draft. J.F., M.K.Z., and L.H. were responsible for the revision of the draft. X.J., Q.L., T.D., Y.X.L., L.J.G., S.J.D. and M.M.M. contributed to data collection. All authors approved the final version of the manuscript before submission.

Corresponding authors

Correspondence to Muke Zhou or Li He.

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Ethical approval statement

This document complies with ethical guidelines and has obtained approval for the observational study from the Biomedical Research Ethics Committee of West China Hospital, Sichuan University. The informed consent was waived due to its retrospective design.

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All authors report no conflicts of interest relevant to this article.

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Liu, Q., Fang, J., Jiang, X. et al. Endovascular thrombectomy for acute ischemic stroke in elderly patients with large ischemic cores. Neurol Sci 45, 663–670 (2024). https://doi.org/10.1007/s10072-023-06995-3

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