Thrombectomy for large strokes in the over-80s: better function, more haemorrhage

Design

Pooled analysis of a cohort study and a randomised trial

Population

270 patients aged ≥80 with large ischaemic stroke (212 EVT, 58 medical treatment)

Primary outcome

90-day modified Rankin scale distribution

Effect

Adjusted common OR 2.83 (95% CI 1.48–5.70); lower mortality, more intracerebral haemorrhage

This Chinese analysis pooled patients aged 80 or over with large ischaemic strokes from a cohort study and a randomised trial: 212 received endovascular treatment and 58 medical treatment alone.

Endovascular treatment was associated with a favourable shift in 90-day modified Rankin scores (adjusted common odds ratio 2.83, 95% CI 1.48–5.70), with more patients reaching each functional threshold and lower 90-day mortality. Any intracerebral haemorrhage was more common after treatment. The benefit did not diminish between those aged 80–84 and 85 or over.

Trials of thrombectomy for large core infarcts enrolled few very old patients, and age alone is still used to withhold treatment. This is supportive evidence that the oldest patients may benefit, but it is largely observational, and the haemorrhage risk must be part of the conversation with the family.

• Consider referral for thrombectomy in patients over 80 with large infarcts, rather than excluding them on age alone.
• Discuss the higher risk of intracerebral haemorrhage alongside the functional benefit.
• Pre-stroke function matters more than chronological age in selecting patients.
• Benefit appeared similar in those aged 85 and over as in those aged 80–84.

Why it matters

Very old patients with large infarcts are often not referred, and this adds evidence that they may still gain.

Don't overread it

Most patients came from a cohort rather than randomised comparison, and the medical group had only 58 patients.

The statistics, in plain English

A common odds ratio of 2.83 means treated patients had nearly three times the odds of being one step better on the Rankin scale at 90 days. The wide interval (1.48–5.70) reflects the small control group.

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