Endovascular Thrombectomy for Acute Ischemic Stroke with Large Infarcts in Older Patients: A Systematic Review and Meta-Analysis of Randomized Clinical Trials
Leonardo Cardoso1, Savio Batista2, Ocilio Goncalves3, Anderson Matheus P da Silva4, Elison Araujo Lima5, Christian Fukunaga6, Matheus Pereira7
1Federal University of Minas Gerais, 2UFRJ, 3Federal University of Piauí, 4Federal University of The São Francisco Valley, 5Federal University of Roraima, 6FMABC University Center, 7University of Valença
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
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