Endovascular Thrombectomy (EVT) shows promise in improving outcomes for stroke patients over 90 years old, according to recent research. The study, published in Academic Radiology, compared the effectiveness of EVT with medical management in 149 patients with acute large vessel occlusion (LVO).
The key finding was that EVT significantly enhanced functional outcomes and reduced mortality rates compared to medical management in this elderly patient group. Lead author Dr. Xiaobo Guan and colleagues emphasize that age should not be a barrier to considering EVT. With increasing life expectancy, the incidence of acute ischemic stroke among nonagenarians is rising, presenting a clinical challenge. The benefit-risk profile of EVT in this elderly population has been a subject of debate.
EVT, a minimally invasive image-guided procedure, dissolves blood clots in stroke patients, restoring blood flow and preventing further brain damage. While it has become standard care for acute ischemic stroke due to LVO, clinical trials supporting its use in patients over 90 have been limited. To address this gap, the research team analyzed outcomes for 52 patients who received EVT and 97 who received best medical management (BMM) between 2020 and 2024.
All patients arrived within 24 hours of symptom onset, with LVO confirmed by CT angiography. The median age was 92, with a slight male majority. The BMM group received various treatments, including thrombolysis, antiplatelet therapy, and neuroprotective agents. Interestingly, patients who later underwent rescue thrombectomy were still classified under BMM, as EVT was not part of their initial treatment.
The study revealed that EVT was associated with better functional outcomes at 90 days, as measured by the modified Rankin scale. The proportion of patients achieving functional independence (mRS 0-2) was higher in the EVT group (15.4%) compared to the BMM group (7.2%). Additionally, more patients in the EVT group achieved a favorable outcome (mRS 0-1) at 6.9%, though this difference was not statistically significant.
Despite the positive findings, the overall clinical outcomes remained poor, with high mortality rates in both groups. This highlights the need for realistic expectations and personalized treatment decisions. The researchers conclude that further research is necessary to optimize patient selection and post-procedural care for this high-risk population.
The full study, published in Academic Radiology, can be accessed here: [https://doi.org/10.1016/j.acra.2025.10.011].
