Results of a meta-analysis suggest that a favourable outcome is more likely if mechanical thrombectomy is added to best medical management (BMM) in elderly patients with anterior circulation stroke due to large vessel occlusion (aLVO). Compared with BMM alone, adding mechanical thrombectomy did not increase mortality.
Mechanical thrombectomy is considered standard treatment for aLVO, but controversy still exists about the risk-benefit ratio and cost-effectiveness of performing this procedure in the elderly. Researchers therefore performed a systematic search to identify randomised trials up to October 2021 comparing treatment of aLVO patients with mechanical thrombectomy or BMM and reporting functional outcome. For this meta-analysis, patients were categorised as either elderly (>70 years) or non-elderly. Outcomes were evaluated based on the modified Rankin Scale score: a score ≤1 was considered excellent, ≤2 good, and ≥5 poor. Dr Aisha Ali (University of Illinois, IL, USA) presented the results .
The inclusion criteria were met by 6 trials: RESILIENT, DAWN, DEFUSE 3, ESCAPE, SWIFT PRIME, and REVASCAT. A total of 1,315 participants were included in the analysis, of whom 873 were non-elderly and 442 were elderly patients. In both age groups, mechanical thrombectomy yielded more favourable outcomes, especially in the non-elderly group. In the non-elderly group, the odds of all outcomes favoured mechanical thrombectomy over BMM:
- excellent outcome (OR 2.86; 95% CI 2.05–3.99; I2=0%);
- good outcome (OR 3.52; 95% CI 2.63–4.70; I2=0%);
- poor outcome (OR 0.5; 95% CI 0.36-0.70; I2=0%);
- mortality (OR 0.53; 95% CI 0.31-0.90; I2=0).
In the elderly group, the odds of all outcomes were also more favourable for mechanical thrombectomy, except for the excellent outcome and mortality:
- excellent outcome (OR 2.24; 95% CI 0.93-5.38; I2=55%), no difference;
- good outcome (OR 2.11; 95% CI 1.11-3.99; I2=46%);
- poor outcome (OR 0.5; 95% CI 0.33-0.75; I2=6%);
- mortality (OR 0.6; 95% CI 0.29-1.22; I2=34%), no difference.
So, even in elderly patients, it appears mechanical thrombectomy should be considered over BMM alone.
- Ali A, et al. Efficacy and safety of mechanical thrombectomy in elderly patients. S17.008, AAN 2022, 02–07 April.
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Table of Contents: AAN 2022
Letter from the Editor
Interview with Prof. Natalia Rost
AAN 2022 Highlights Podcast
Alzheimer’s Disease and Other Dementias
Targeting senescent cells to treat age-related diseases
Cardiorespiratory fitness protects against dementia
Safety and effects of bosutinib in Lewy body dementia
“Women with epilepsy should be encouraged to breastfeed”
Fenfluramine: possible new treatment for Lennox-Gastaut syndrome
Laser interstitial thermal therapy for refractory epilepsy
Migraine may be an important obstetric risk factor
Intranasal zavegepant safe and well tolerated in healthy adults
Telemedicine during COVID-19 pandemic highly appreciated
Ublituximab versus teriflunomide in relapsing MS patients
Ketogenic diet may improve disability and quality of life
Favourable additional safety data for ofatumumab
Predicting new T2 lesions using a machine learning algorithm
Evobrutinib reduces volume of slowly expanding lesions
Sustained long-term efficacy and safety of satralizumab in NMOSD
Muscle and Neuro-Muscular Disorders
Ravulizumab in patients with generalised myasthenia gravis
Gene therapy effective in older patients with spinal muscular atrophy
Losmapimod for facioscapulohumeral muscular dystrophy
SRP-9001 for treating patients with Duchenne muscular dystrophy
Cerebrovascular Disease and Stroke
Intravenous thrombolysis after ischaemic stroke: When in doubt, leave it out?
Better outcomes with mechanical thrombectomy in elderly stroke patients
Plasma NfL levels associated with cardiovascular risk
Non-invasive vagus nerve stimulation for acute stroke
Prasinezumab in Parkinson’s disease: delayed-start analysis of PASADENA trial
IPX203 versus immediate release carbidopa-levodopa
Impact of COVID-19 public health interventions
Cognitive, EEG, and MRI features in COVID-19 survivors
Neurological manifestations of COVID-19 worsen prognosis
New evidence for biological basis of “COVID-19 brain fog”