Endovascular Thrombectomy for Acute Ischemic Stroke in Elderly Patients with Large Ischemic Cores

AbstractBackground: As the combined effects of advanced age and extensive brain infarction can have a greater negative impact on clinical outcomes, a real-world data analysis is necessary to fully understand the benefits and risks of endovascular therapy (EVT) in this population. 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. EVT may help patients achieve functional independence. The benefits of EVT numerically exceeded non-EVT treatment for those aged ≤ ~ 85 years or with a mismatch volume ≥ ~ 50ml. However, EVT showed increased risk of symptomatic ICH after adjustment (aOR 7.279, 95%CI 1.131–46.845). Conclusion: This study highlights the significant clinical challenges faced by elderly patients with large infarction, with poor outcomes observed at 3 months. While EVT may offer some benefits, it also comes with increased risk of ICH.