ABSTRACT NUMBER: ESOC2026A1615 MECHANICAL THROMBECTOMY IN ACUTE ISCHEMIC STROKE IN VERY ANCIENT PATIENTS (≥90 YEARS OLD): EXPERIENCE IN 39 PATIENTS IN A LARGE TERTIARY CARE CENTRE

Abstract Background and aims Mechanical thrombectomy has revolutionized the treatment of acute ischemic stroke due to large vessel occlusion, demonstrating functional benefit without a significant increase in mortality. However, there are no randomized controlled trials in patients older than 90 years, and the available evidence derives from studies with lower levels of scientific evidence. Methods Data from 39 patients aged ≥90 years with acute ischemic stroke treated with mechanical thrombectomy at Hospital Universitario de Basurto between January 2018 and December 2023 were analyzed. Information on modified Rankin Scale (mRS) scores and events significantly affecting functional status during the first two years after the procedure was collected. Results The median age of the patients in the sample was 91 years. The rate of intracranial hemorrhage was 28.21%, and in-hospital mortality was 17.85%. Cumulative mortality at one month, three months, one year, and two years was 28.13%, 37.5%, 56.25%, and 71.8%, respectively. Among survivors, 56.25% at discharge and 15.63% at two years maintained a mRS ≤3. In contrast, 40.63% experienced an acute event that worsened functional status, with cognitive decline and cardiological pathology being the most frequent complications, affecting 46.16% and 30.78% of patients, respectively. Conclusions The rates observed in our study are comparable to those reported in other series. Therefore, we believe that mechanical thrombectomy in nonagenarians may provide functional benefit in selected cases, albeit with high mortality and a higher rate of functional dependence compared with younger patients. Exclusion based solely on age is not recommended; individualized patient selection is essential. Conflict of interest Diego Armenteros Gómez: nothing to disclose