Safety of endovascular therapy in ischemic stroke patients ⩾90 years: A cohort study from the EVA-TRISP collaboration

Introduction: Data on safety of endovascular therapy (EVT) in the very elderly are scarce. Using data from a large prospective EVT registry, we aimed at providing better evidence for EVT decision-making in patients aged 90 years and older. Patients and methods: In this multicentre observational study from the EVA-TRISP collaboration outcomes were compared between patients aged ⩾90 years with those aged <90 years using multivariate logistic regression analysis and reporting odds ratios and 95% confidence intervals. Outcomes were occurrence of poor functional outcome in survivors (modified Rankin Scale (mRS) 3–5 if pre-stroke mRS 0–2 and mRS higher than pre-stroke mRS if pre-stroke mRS 3–5), mortality at 3 months after stroke, unsuccessful recanalization (mTICI 0–2a) and symptomatic intracranial hemorrhage (sICH, defined by ECASS-II-/III-criteria). Results: Of 13,306 eligible patients, 892 were ⩾90 years old (6.7%). The very elderly had a higher median National Institutes of Health Stroke Scale (NIHSS) on admission (16 vs 14) and were more likely to have a pre-stroke mRS of 3–5 (38.0% vs 8.7%). The odds of poor functional outcome (OR $_{adjusted}$ 2.35 (95%-CI 1.87–2.97); 61.6% vs 38.7%), death (OR $_{adjusted}$ 3.04 (95%-CI 2.60–3.55); 53.9% vs 21.3%) and unsuccessful recanalization (OR $_{adjusted}$ 1.34 (95%-CI 1.14–1.57); 32.4% vs 27.2%) were higher in patients aged ⩾90 years. The odds of sICH did not differ (OR $_{adjusted}$ 0.92 (95%-CI 0.66–1.28); 5.1% vs 5.0%). Discussion and conclusion: EVT-treated stroke patients ⩾90 years had higher odds of poor functional outcome, mortality and unsuccessful recanalization than younger patients. However, the probability of sICH after EVT was not increased. The decision in favor of or against EVT in the very elderly should not be based on age alone.