Thrombectomy in Octogenarians in the Era of Stent Retriever: Is an Age Limit Necessary?

Abstract

Objective: The results of thrombectomy in people aged 80 years and above were reviewed, and the necessity of an age limit was evaluated.

Methods: Seventy eight patients who underwent thrombectomy at our hospital between July 2014 and September 2016 were divided into those aged <80 years and those aged ≥80 years, and the therapeutic results and outcome were evaluated.

Results: The patients consisted of 25 aged ≥80 years (≥80 years group) and 53 aged <80 years (<80 years group). The mean time from puncture to recanalization was 56 and 65 minutes, respectively, and thrombolysis in cerebral infarction score of 2b or better recanalization was observed in 96.0 and 88.7%, respectively, with no significant difference in either parameter. Change of the approach route was necessary in five patients aged ≥80 years (20.0%). A favorable outcome with a modified Rankin scale (mRS) score of ≤2 was observed 3 months after the onset in 44.0 and 64.2%, respectively, being slightly lower in the ≥80 years group (P = 0.151). In the ≥80 years group, the time from the onset to recanalization was a poor prognostic factor (P = 0.048).

Conclusion: In the patients aged ≥80 years, the recanalization rate, procedural time, and complication rate in thrombectomy were comparable to those in the patients aged <80 years, and no significant difference was observed in the outcome. Therefore, aggressive intervention without an age limit is considered recommendable in preoperatively activities of daily living (ADL)-independent elderly patients expected to be good candidates for simple thrombectomy. However, with the possibility of change in the approach route in mind, it is necessary to achieve recanalization more promptly in older patients.