Endovascular treatment in elderly for acute vertebrobasilar artery occlusion: a multicenter registry

BACKGROUND AND OBJECTIVES: The benefit of endovascular treatment (EVT) for patients with large vessel occlusion aged ≥ 80 years remains unknown. We aimed to explore clinical outcomes of EVT versus best medical management (BMM) alone in patients with vertebrobasilar artery occlusion (VBAO) aged ≥ 80 years. METHODS: This retrospective multicenter study included patients with VBAO and age ≥ 80 years at 65 centers in China between December 2015 and June 2022. The primary outcome was a favorable modified Rankin scale score of 0-3 at 90 days. Propensity score weighting using the inverse probability of treatment weighting (IPTW) was performed to achieve a balance in the baseline covariates. To determine the association between treatment allocation and outcomes, we constructed a multivariable mixed logistic regression model with center as a random effect for both pre- and post-weighting cohorts. RESULTS: The study included 418 patients. Among these, 203 and 215 were in the BMM and EVT groups, respectively. After multivariable regression analysis, compared with BMM alone, EVT was associated with increased favorable outcome (OR 1.74, 95% CI 1.30-2.31, P < 0.001; IPTW, OR 2.61, 95% CI 1.77-3.85, P < 0.001). Symptomatic intracerebral hemorrhage did not differ between the two groups. CONCLUSIONS: EVT may be beneficial for patients with VBAO and age ≥ 80 years when performed with careful consideration by neuro-interventionalist. But the determination of the age cutoff of EVT benefit in patients with VBAO still needs further research.