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Abstract Details

Efficacy and Safety of Mechanical Thrombectomy in Elderly Patients
Cerebrovascular Disease and Interventional Neurology
S17 - Cerebrovascular Disease: Clinical Trials and Outcomes Studies (4:54 PM-5:06 PM)
MT is considered the standard treatment for aLVO. However, there is uncertainty in relation to the efficacy of MT vs. BMM alone in the elderly.
This meta-analysis compares the effect of mechanical thrombectomy (MT) plus best medical management vs. best medical management (BMM) alone for the treatment of elderly patients presenting with anterior circulation stroke due to large vessel occlusion (aLVO).
We performed a systematic search of medical databases from inception to October 2021 to identify randomized studies that reported the functional outcome at 90 days for elderly patients with aLVO treated with MT vs. BMM. Patients were divided into elderly (>70 or >80 years, depending on the cut-off used in each study) and non-elderly. Outcomes were defined as excellent (modified Rankin Scale [mRS]≤1), good (mRS≤2), or poor (mRS≥5). Effect sizes ware calculated by using random effect meta-analysis, results were represented by odds ratio (OR) and 95% confidence intervals (95%CI), and heterogeneity was assessed by I2 and Cochrane’s Q statistics.

Six trials (RESILIENT, DAWN, DEFUSE 3, ESCAPE, SWIFT PRIME, and REVASCAT) met the inclusion criteria and 1315 patients were included in the analysis (elderly n= 442). In the non-elderly group, the odds of excellent outcome (OR 2.86; 95%CI 2.05-3.99; I2=0%), good outcome (OR 3.52; 95%CI 2.63-4.70; I2=0%), poor outcome (OR 0.5; 95%CI 0.36-0.70; I2=0%), and mortality (OR 0.53; 95%CI 0.31-0.90; I2=0) favored MT over BMM. Among the elderly, the odds of good outcome (OR 2.11; 95%CI 1.11-3.99; I2=46%) and poor outcome (OR 0.5; 95%CI 0.33-0.75; I2=6%) favored MT. No differences were observed for excellent outcome (OR 2.24; 95%CI 0.93-5.38; I2=55%) and mortality (OR 0.6; 95%CI 0.29-1.22; I2=34%).

In elderly patients with aLVO, MT increases the likelihood of achieving a good outcome and does not increase mortality. In this group, MT should be considered over BMM alone.
Aisha Ali
Dr. Ali has nothing to disclose.
Gabriela Trifan (UIC, Department of Neurology) Dr. Trifan has nothing to disclose.
Fernando Testai (University of Illinois at Chicago) Dr. Testai has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Testai has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Swanson Martin & Bell, LLP. Dr. Testai has received publishing royalties from a publication relating to health care.