(1209) Predictors of Poor Outcomes in Octogenarian Patients Undergoing Mechanical Thrombectomy

Introduction: Endovascular thrombectomy (EVT) is the standard of care for select patients with acute ischemic stroke due to large vessel occlusion (LVO). While recanalization of LVOs is a strong predictor of good outcomes, many patients, especially the elderly, still suffer significant neurological disability despite successful EVT. Clinical characteristics and drivers for poor outcomes among elderly patients have not been well described.

Methods: Endovascular thrombectomy (EVT) is the standard of care for select patients with acute ischemic stroke due to large vessel occlusion (LVO). While recanalization of LVOs is a strong predictor of good outcomes, many patients, especially the elderly, still suffer significant neurological disability despite successful EVT. Clinical characteristics and drivers for poor outcomes among elderly patients have not been well described.

Results: 351 EVT patients were identified, of whom 53 (15.1%) were octogenarians. Overall, while octogenarians were treated with EVT in a similarly timely manner and achieved similar rates of successful reperfusion (p>0.05 for both), elderly patients had significantly lower odds of functional independence at 90 days (15% vs. 42%; p< 0.001). Octogenarians had more severe stroke symptoms (Median NIH stroke scale 17 [Interquartile [12.0-20.0] vs 21.0 [16.0-24.0]; p< 0.001) and more frequently required mechanical ventilation (60% vs. 45%, P=0.03). Stroke severity (OR 0.94, 95% CI 0.8988, 0.978, p=0.003) and mechanical ventilation (OR 0.17, 95% CI 0.0751, 0.3866, P< 0.001) were both independently associated with poor outcomes.

Conclusions: Octogenarians are at increased risk for poor neurological outcomes compared to younger patients despite equally timely and successful EVT. More severe stroke symptoms and more frequent need of mechanical ventilation among the elderly population may partially explain this phenomenon.