Abstract Details

Title Endovascular Thrombectomy for Acute Ischemic Stroke with Large Infarcts in Older Patients: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (11:45 AM-12:45 PM)

Poster/Presentation
Number 13-017

Objective

To evaluate the efficacy of endovascular thrombectomy (EVT) in patients over 70 years old with acute ischemic stroke (AIS) and large infarctions.

Background

The role of thrombectomy in patients with large infarcts remains underexplored, especially among older populations. Trials of EVT for AIS typically exclude patients with Alberta Stroke Program Early CT Scores (ASPECTS) below 5. While some randomized clinical trials (RCTs) have investigated EVT in these high-risk patients, data specific to the elderly are limited, and many studies have not demonstrated a clear benefit for this age group.

Design/Methods A systematic search was conducted across MEDLINE, Embase, Cochrane, and Web of Science to identify relevant RCTs. The inclusion criteria were RCTs comparing EVT with standard medical care in AIS patients with large infarcts (ASPECTS ≤ 5), with data available for older patients. Key outcomes included the odds ratio (OR) for functional recovery at 90 days, defined as a reduction of at least one point on the modified Rankin Scale (mRS), and the proportion of patients achieving favorable functional outcomes (mRS 0-3) at 90 days. Pooled ORs and Risk Ratios (RR) with 95% confidence intervals were calculated using a random-effects model, with heterogeneity assessed via I² statistics.

Results

Five RCTs involving 620 older patients were included, with 307 (49.5%) receiving EVT. Patients were enrolled from 192 centers across multiple countries. At 90 days, EVT was associated with better functional recovery (OR = 1.38, 95% CI: 1.15–1.67; p < 0.01; I² = 0%) and higher rates of favorable functional outcomes (RR = 2.95, 95% CI: 1.61–5.41; p < 0.01; I² = 0%).

Conclusions

This meta-analysis indicates that older patients with large infarcts benefit more from endovascular thrombectomy than from standard medical management alone, showing improved functional outcomes and recovery rates

Authors/Disclosures
Leonardo J. Cardoso, MS PRESENTER	Mr. Cardoso has nothing to disclose.
Savio Batista, MD (Emory University)	Mr. Batista has nothing to disclose.
Ocilio R. Goncalves, MS	Mr. Goncalves has nothing to disclose.
Anderson Matheus P da Silva, Sr., PhD	Prof. P da Silva has nothing to disclose.
Elison E. Araujo Lima, MD	Dr. Araujo Lima has nothing to disclose.
Christian K. Fukunaga, MS (Medical Student)	Mr. Fukunaga has nothing to disclose.
Matheus D. Pereira, MD	Dr. Pereira has nothing to disclose.

��ɫ��

��ɫ��