ABSTRACT NUMBER: ESOC2026A2337 IMPACT OF ARTERIAL RECANALIZATION BY MECHANICAL THROMBECTOMY IN PATIENTS AGED 80 YEARS OR OLDER WITH A LARGE INFARCT (ASPECTS 0–5)

Abstract Background and aims Mechanical thrombectomy improves functional outcomes in patients with large infarcts (ASPECTS 0–5), but patients aged 80 years or older were excluded from previous randomized studies. This age group accounted for about 32% of thrombectomy procedures in France in 2024. We aimed to assess the impact of thrombectomy in this population. Methods We retrospectively analyzed the ETIS registry, including patients aged 80 years or older with a proximal cerebral vessel occlusion in the anterior circulation and a large infarct (ASPECTS 0–5), admitted between 01/01/2017 and 31/12/2024. Patients were classified according to arterial recanalization after thrombectomy (mTICI ≥2b vs <2b). The primary endpoint was 90-day modified Rankin Scale (mRS). Secondary endpoints included 7-day and 3-month mortality, and symptomatic/asymptomatic intracranial hemorrhage. Results A total of 642 patients were included (median age 85 years; 390 women; median ASPECTS 4), of whom 87.2% (560/642) achieved mTICI ≥2b. Successful recanalization was associated with improved 3-month functional outcome (mRS 0–3; adjusted OR 2,70 ; 95% CI 1,21-6,40 ; p = 0,016) and reduced mortality at day 7 and 3 months (adjusted OR 0,41 ; 95% CI 0,27 – 0,72 ; p < 0,001; adjusted OR 0,44; 95% CI 0,26 – 0,75 ; p = 0,002, respectively), without increased hemorrhagic complications or procedure-related adverse events. Conclusions In patients aged 80 years or older with a proximal cerebral vessel occlusion in the anterior circulation and a large infarct, mechanical thrombectomy is associated with better functional outcomes and lower mortality, without higher risk of hemorrhagic or procedural complications. Conflict of interest Bertrand Lapergue has received fundings by Terumo (outside this work)