Abstract T P3: The Impact of Mechanical Thrombectomy in Patients Over 80 Years of Age

Abstract

Many physicians debate the efficacy of mechanical thrombectomy (MT) for acute ischemic stroke (AIS), but most agree that to establish the true benefit there needs to be improved patient selection. The elderly are the fastest growing age group in the USA and present a growing population of AIS patients. The benefit of MT for these patients may be greatly reduced due to diminishing neuroplasticity and a larger number of medical co-morbidities at the time of intervention. The paucity of data on this intervention in the elderly limits the physician’s ability to adequately counsel patients and their families regarding any potential benefit from this emergent intervention. To address this knowledge gap, our objective was to examine clinical and economic outcomes after MT in the AIS population from the Nationwide Inpatient Sample (2008-2010). Our hypothesis was that patients > 80 years of age would fare worse at discharge in comparison to their younger counterpart. Independent samples t-tests and chi-squared tests were used to make comparisons. Multivariable models, adjusted for confounding factors, investigated outcomes. Less than 1% of all AIS cases were treated with MT. Of these, 18% (9300 cases) involved patients > 80 years. The odds of mortality in elderly patients treated with MT were more than double that of younger patients (OR:2.11, P<.001) and there was a significant reduction in the odds of being discharged home (OR:0.30, P<.001). Although univariate analysis depicted a significant difference in hospital charges and length of stay, multivariate analysis revealed no significant differences. In conclusion, patients > 80 years experienced worse clinical outcomes than their younger counterpart. Studies to better identify specific subpopulations of patients, in all age groups, that would benefit from mechanical thrombectomy are needed urgently.