Mechanical thrombectomy in elderly stroke patients with low ASPECTS: insights from STAR.
Publication/Presentation Date
6-1-2025
Abstract
BACKGROUND: The elderly population (≥80 years) were underrepresented in recent trials of endovascular thrombectomy (EVT) for anterior circulation large vessel occlusion acute ischemic stroke (LVO-AIS) with low Alberta Stroke Program Early CT Score (ASPECTS) (≤5).
METHODS: This study analyzed data from a prospectively maintained database of 37 thrombectomy centers. The primary cohort of the study comprised patients with LVO-AIS aged ≥80 who underwent EVT with ASPECTS≤5 from 2013 to 2023. The primary outcome was favorable modified Rankin Scale (mRS) score of 0-3. Propensity score matching (PSM) and multivariate regression were applied.
RESULTS: In a study of 14 233 patients undergoing EVT, 1741 patients were 80 or older, with 122 presenting with low ASPECTS. While successful recanalization rates were similar between age groups, patients aged ≥80 had significantly lower favorable 90-day mRS scores and higher mortality before propensity score matching (PSM). After PSM, differences in mortality and symptomatic intracranial hemorrhage (sICH) were no longer significant. Among all elderly patients, higher ASPECTS was an independent predictor of a 90-day favorable outcome but was not associated with 90-day mortality. For patients aged ≥80 years with low ASPECTS, favorable outcomes were associated only with lower rates of atrial fibrillation, baseline functioning (mRS 0-1), fewer thrombectomy passes, and higher likelihood of first-pass reperfusion within 30 min of puncture.
CONCLUSION: While age ≥80 increases mortality and disability in patients with AIS and low ASPECTS, select elderly patients may still benefit from EVT when clinical factors are considered, supporting individualized treatment and better patient selection for future trials.
Volume
17
Issue
e2
First Page
206
Last Page
206
ISSN
1759-8486
Published In/Presented At
Cunningham, C., Hubbard, Z., Abo Kasem, R., Elawady, S. S., Sowlat, M. M., Matsukawa, H., Maier, I., Jabbour, P., Kim, J. T., Wolfe, S. Q., Rai, A. T., Starke, R. M., Psychogios, M. N., Samaniego, E. A., Goyal, N., Yoshimura, S., Cuellar, H., Howard, B. M., Alawieh, A., Alaraj, A., … Spiotta, A. M. (2025). Mechanical thrombectomy in elderly stroke patients with low ASPECTS: insights from STAR. Journal of neurointerventional surgery, 17(e2), e206–e215. https://doi.org/10.1136/jnis-2024-022677
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
39855673
Department(s)
Administration and Leadership
Document Type
Article