Endovascular Thrombectomy for Acute Ischemic Stroke in Elderly Patients

Endovascular thrombectomy has emerged as a cornerstone intervention for acute ischaemic stroke caused by large vessel occlusion, offering the possibility of rapid mechanical clot removal. In elderly patients, who often present with greater stroke severity, more comorbidities and increased frailty, the balance of procedural risks and functional benefit requires careful evaluation. Recent advances in device design, imaging selection and periprocedural management have broadened the age spectrum of candidates, demonstrating that advanced age alone should not be an exclusion criterion. Outcomes in octogenarians and nonagenarians remain less favourable than in younger cohorts, with higher rates of mortality and disability, but a meaningful proportion still achieve functional independence at three months. Predictors of poor outcome include baseline stroke severity, prolonged onset-to-puncture times, general anaesthesia and absence of adjunctive intravenous thrombolysis. Technological improvements, streamlined workflows and refined patient selection are gradually narrowing the gap between younger and older patients, underscoring the global importance of individualised decision-making in the ageing population.

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Endovascular Thrombectomy for Acute Ischemic Stroke in Elderly Patients publication trend

The graph below shows the total number of articles in endovascular thrombectomy for acute ischemic stroke in elderly patients across all publications each year (not limited to Nature Index journals).

Technical terms

Endovascular thrombectomy: Percutaneous mechanical removal of intracranial thrombus via catheterisation to restore cerebral blood flow.

Large vessel occlusion (LVO): Acute blockage of a major cerebral artery (e.g. internal carotid, middle cerebral) causing extensive ischaemia.

Recanalization: Restoration of blood flow in occluded vessels, typically graded by the modified Thrombolysis in Cerebral Infarction scale.

Modified Thrombolysis in Cerebral Infarction (mTICI) scale: Five-point grading system (0–3) indicating degree of perfusion achieved after thrombectomy.

National Institutes of Health Stroke Scale (NIHSS): Quantitative tool measuring neurological deficit severity in acute stroke patients.

Modified Rankin Scale (mRS): Ordinal scale (0–6) assessing global disability and dependence in daily activities after stroke.

Futile recanalization: Successful angiographic reopening of an occluded vessel that does not translate into clinical improvement at follow-up.

References

1. Predictors of futile recanalization in nonagenarians treated with mechanical thrombectomy: a multi-center observational study. Journal of Neurology (2024).
2. Acute stroke treatment and outcome in the oldest old (90 years and older) at a tertiary care medical centre in Germany-a retrospective study showing safety and efficacy in this particular patient population. BMC Geriatrics (2021).
3. Functional Outcomes at 90 Days in Octogenarians Undergoing Thrombectomy for Acute Ischemic Stroke: A Prospective Cohort Study and Meta-Analysis. Frontiers in Neurology (2019).
4. Impact of age on mechanical thrombectomy and clinical outcome in patients with acute ischemic stroke. Journal of Stroke and Cerebrovascular Diseases (2023).