Retrievable stent thrombectomy in acute ischemic stroke: Is it beneficial in the elderly?

Abstract

Mechanical thrombectomy in acute stroke is used in case of systemic thrombolysis failure or contraindication. Stent retrievers have proved to be safe and efficient. However, this therapy is still under debate in the elderly. Patients ineligible for systemic thrombolysis, treated with stent retrievers’ thrombectomy only were studied. We aimed to analyze the outcome (rate of recanalization and functional independence) and the safety (intracranial hemorrhage and mortality) of elderly (≥75years) in a series of patients with ischemic stroke due to acute proximal MCA occlusion treated with stent-based thrombectomy. In 65 consecutive acute ischemic stroke patients ineligible for systemic thrombolysis, outcomes of elderly patients (16/32 women; 12/33 men) were compared to those of younger (<75years) patients (17/32 women; 20/33 men). Admission NIHSS was not significantly different between younger and elderly patients. Recanalization was completely achieved in 49 cases (72%) and didn't differ between younger and older patients (Fisher’s exact p>0.05). NIHSS improvement before and after stent retriever recanalization was highly significant in younger (p<0.0001) and in older patients (p<0.0001). However, the size of improvements did not differ significantly between younger and older patients (p=0.17). Good functional outcome (mRS 0–2) was significantly worse in the elderly (Fisher’s exact p>0.0006), but there were no gender differences (Fisher’s exact p>0.05). Hemorrhagic transformation did not differ significantly. These results suggest that stent-based thrombectomy in selected patients for acute MCA occlusion is safe, very effective, associated with improved neurological outcome and should be considered in elderly patients without gender consideration.