Mechanical thrombectomy for elderly stroke patients: An updated systematic review and meta-analysis of randomized clinical trials.
Leonardo Januário Campos Cardoso, Ahmet Günkan, Marcio Yuri Ferreira et al.
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In 30 seconds
This systematic review and meta-analysis pooled randomized clinical trials comparing mechanical thrombectomy (MT) with standard medical management for acute ischemic stroke in patients over 70 years. Across 15 trials involving 1481 elderly patients, MT was associated with better functional recovery (OR 1.54; 95% CI: 1.22-1.94; P < .01), higher rates of excellent and good outcomes, and lower rates of poor outcomes and mortality at 90 days. The authors conclude that MT may benefit selected elderly patients, while noting limited elderly-specific safety data and selective trial populations.
Key findings
- MT was associated with better functional recovery: OR 1.54; 95% CI: 1.22-1.94; P < .01.
- Excellent outcomes were more frequent with MT (RR 1.60; 95% CI: 1.11-2.30; P = .01), as were good outcomes (RR 1.84; 95% CI: 1.45-2.35; P < .01).
- MT was associated with fewer poor functional outcomes (RR 0.71; 95% CI: 0.58-0.85; P < .01) and lower mortality (RR 0.65; 95% CI: 0.45-0.96; P = .03).
- Subgroup results were consistent across age threshold, circulation territory, and country socioeconomic status analyses.
Why it matters
Older adults with acute ischemic stroke may have substantial functional and survival benefit associated with thrombectomy, addressing uncertainty about outcomes in this population. The findings support considering evidence from elderly patients rather than assuming results in the general trial population apply uniformly, while the review’s cautions underscore the need to interpret pooled estimates in light of limited safety data and selective enrollment.
What to keep in mind
The authors note limited elderly-specific safety data and selective trial populations, which may constrain how well the findings apply to older patients outside those trials.