Poor outcomes of elderly patients undergoing multimodality intra-arterial therapy for acute ischemic stroke

• Acute ischemic stroke (AIS) is prevalent in the elderly population.
• Intra-arterial therapy (IAT) can achieve high vessel recanalization rates in AIS.
• In our series, 40% of IAT patients less than 80 years had a good functional outcome.
• Despite modern IAT, 0% of our elderly patients achieved a good functional outcome.
• Practitioners should exercise caution when offering IAT to elderly AIS patients.

ObjectiveThe incidence of acute ischemic stroke is highest in the elderly. Information regarding outcomes of elderly patients undergoing different modalities of intra-arterial therapy (IAT) for acute ischemic stroke (AIS) is scarce and conflicting. This study compares the safety, technical efficacy and outcomes of elderly patients (≥80 years) to non-elderly patients (<80 years) who underwent multimodality IAT.MethodsFrom a registry of consecutive patients treated with IAT for AIS at our institution over a 3.5-year period, patients with anterior circulation occlusions aged ≥80 years were compared to the patients <80 years.ResultsBetween 2008 and 2012, 24 patients ≥80 years (elderly) and 95 patients <80 years (non-elderly) received IAT for anterior circulation occlusions. In the elderly, there were more females (66.7% vs. 28.4%, p = <0.001) and atrial fibrillation (58.3% vs. 25.2%, p = 0.003). Between the 2 groups, there was no difference in NIHSS score (17.2 vs. 16.3, p = 0.17), THRIVE score (4.21 vs. 4.39, p = 0.633), recanalization rate (70.1% vs. 85.3%, p = 0.13), or severe reperfusion hemorrhages (8.3% vs. 4.2%, p = 0.425). There was no significant difference in 3-month mortality (33.3% vs. 16.8%, p = 0.28); however, fewer elderly patients reached good 3-month outcome (0% vs. 40.0%, p = <0.001). After controlling for baseline factors, only female gender (OR 5.3, 95% CI 1.7–16.7; p = 0.04) and higher 3-month mRS (OR 1.6; 95% CI 1.1–2.40; p = 0.008) were independently associated with elderly age.ConclusionDespite similar safety profiles and recanalization rates, elderly patients had poor functional outcomes after IAT. Intra-arterial therapy in the elderly should be pursued very cautiously only after careful analysis of the risks and benefits for each patient.