Age alone should not deny thrombectomy in large ischaemic stroke

Design

Pooled cohort and randomised-trial data; adjusted comparison

Population

270 patients aged 80 or older with large ischaemic stroke (212 had endovascular treatment)

Primary outcome

90-day modified Rankin scale distribution

Effect

Adjusted common odds ratio 2.83 (95% CI 1.48-5.70); lower mortality; more intracranial haemorrhage

Pooling a cohort study and a randomised trial, investigators compared endovascular treatment with standard medical treatment in 270 patients aged 80 or older with large ischaemic stroke, with 90-day disability (modified Rankin scale) as the primary outcome.

Endovascular treatment shifted the 90-day disability distribution towards better outcomes (adjusted common odds ratio 2.83, 95% CI 1.48 to 5.70) and lowered 90-day mortality, though any intracranial haemorrhage was more common. Importantly, the benefit did not diminish with increasing age within this group, including those 85 and older.

The practical message is to assess the oldest patients with large-core stroke for thrombectomy on their individual profile, not to exclude them on age alone, while counselling on the raised bleeding risk. The evidence pools observational and trial data, so selection still matters, but it argues against a hard age cut-off.

• In patients 80 or older with large ischaemic stroke, thrombectomy improved 90-day function (common odds ratio 2.83).
• Ninety-day mortality was lower with thrombectomy than medical treatment alone.
• Intracranial haemorrhage was more common with thrombectomy.
• The benefit did not fall with increasing age, including those 85 and older.
• Assess the oldest large-stroke patients individually rather than excluding them by age.

Why it matters

It challenges the reflex to withhold thrombectomy from the very elderly with large strokes.

Don't overread it

This pools cohort and trial data and carries a higher haemorrhage rate, so it supports individualised selection, not blanket treatment of all very elderly patients.

The statistics, in plain English

A common odds ratio of 2.83 means markedly higher odds of a better disability category across the whole scale; because the analysis pools trial and observational data, residual selection could inflate the benefit.

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