Thrombectomy in acute stroke therapy: Feasible for very old patients, but not without risks

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The mechanical removal of blood clots in acute stroke is highly effective but not suitable for all patients. This is a finding of a recent study presented at the 4th Congress of the European Academy of Neurology (EAN 2018; 16–19 June, Lisbon, Portugal). Thrombectomy can also help very old patients age 80 and over to achieve a life free of disabilities following a stroke. But the risks involved are considerable.

Numerous international studies have shown that endovascular treatment is a substantial improvement over purely drug-based therapy. The procedure is especially effective in dealing with extremely long blood clots and large obstructions of the cerebral arteries and often yields positive results: Thanks to this procedure, more than 60% of those treated survive the stroke without any subsequent impairment or with only minor subsequent impairment.

Ary Lopes de Sousa (Lisbon) reported: “More and more study results show the high effectiveness of mechanical removal of blood clots after a stroke. But researchers are still trying to determine the type of patient for whom this relatively new procedure is the best treatment option.”

De Sousa and his colleagues reviewed the treatment success of thrombectomy in more than 200 patients who had suffered an anterior acute ischaemic stroke (AIS) and had no or only slight disability prior to this event. The patients were divided into two groups: one with individuals under 80 years old and one with individuals 80 years and older.

In the group of elderly patients age 80 and older hypertension was more frequent, the same goes for transitory ischaemic attacks. The actual treatment did not differ for the two groups, e.g. in terms of the time frame of the revascularisation. But in the older group, two thirds of the patients exhibited a poor functional outcome at three months after the treatment, i.e. they were moderately or severely limited in their ability to handle their daily tasks. The number of impaired individuals was substantially larger there than in the younger group, where just short of half (46%) faced limitations in their everyday lives. On the other hand, one third of the patients age 80 and older were able to handle their everyday lives three months after the treatment with no or mild impairments from the stroke. In terms of death, no difference was observed between the two age groups.

De Sousa: “For patients over 80, thrombectomy appears to be riskier than for younger patients. But one third of the patients over 80 can be fully functional in their everyday lives after the procedure, so we must identify the factors associated with this favourable outcome. This will support us applying this modern procedure efficiently to those individuals among the very old who can benefit from it.”

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