Abstract A008: Endovascular <i>Thrombectomy in Very Elderly Stroke Patients: National Utilization and Clinical Outcomes, 2016-2022</i>

Background: Endovascular thrombectomy (EVT) is the standard of care for large vessel occlusion stroke, but its use in very elderly patients (≥ 80 years) has been limited by concerns about poor outcomes. Although prior studies suggested lower EVT use and worse outcomes in this population, it remains unclear whether these patterns persist in current U.S. practice. Methods: We used the Nationwide Inpatient Sample (2016–2022) to identify adults (≥18 years) with a primary discharge diagnosis of ischemic stroke admitted non-electively. Patients were stratified into two groups: &lt;80 vs ≥80 years. The primary outcome was EVT utilization. Secondary outcomes included in-hospital mortality and discharge home. Analyses were conducted using unweighted and weighted estimates, with NIS survey weights applied to obtain nationally representative results. Results: The cohort included 721,143 patients. 207,216 (28.7%) were aged ≥80. EVT utilization was similar between age groups (5.5 % in &lt;80 vs 5.2% in ≥80) and increased steadily from 2016 to 2022 in both groups. By 2021-2022, utilization was comparable across age groups, suggesting that age was no longer a barrier ( Figure 1 , Table 1) . In-hospital mortality remained higher in the ≥80 group compared with younger patients (6.0% vs 3.1%), discharge home in ≥80 group were also lower in the &lt;80 group (17-19% vs 43-45%) (Table 1, Figure 2 ). Both mortality and discharge home rates in very elderly patients were stable across the study period, with no evidence of worsening outcomes as EVT was expanded. Conclusion: In this large, nationally representative cohort, EVT utilization did not differ significantly between patients ≥80 years and younger patients (&lt;80 years) with non-elective ischemic stroke. This suggests that age is no longer a barrier to thrombectomy in the U.S. As expected, very elderly patients continued to experience higher in-hospital mortality and lower rates of discharge home, reflecting their greater baseline risk. Notably, these outcomes have remained stable over time, indicating that broader EVT adoption in this population has not worsened mortality or discharge disposition at the population level. These findings highlight the broad adoption of EVT across age groups and its application in very elderly patients.