Background:
Randomized clinical trials (RCTs) suggest a benefit of mechanical thrombectomy (MT) even for individuals ≥ 80 years of age; however, this population has not been consistently included in RCTs, and the eldest (≥85 years) are underrepresented. Small observational studies suggest that elderly patients experience a higher proportion of in-hospital complications, mortality, and poor functional outcome defined as modified Rankin Scale Score (mRS) ≥4. While MT is generally recommended in this population, little is known about how decisions are made to undergo MT or subsequently to withdraw or withhold life-sustaining treatments (WoLST). The goal of this study was to describe a single center experience of elderly patients who underwent MT.
Methods:
We identified all patients admitted to our comprehensive stroke center from June 2016 - June 2018 who were ≥85 years old and underwent successful MT, defined as TICI 2a to 3. We collected data from the electronic medical record, including WoLST. A good outcome was defined as a mRS of 0-2 at 90 days.
Results:
We identified a total of 29 patients with successful MT with a mean age of 88.4 years (SD=3.6); 66% were women. Only one patient (3.4%) achieved a good outcome, while 65.5% died (see figure). Among decedents, 47.4% expired during their initial hospitalization, while 15.8% were discharged to hospice. A decision for WoLST was made in 11 patients, 88.9% of in-hospital decedents.
Discussion:
In our retrospective study of 29 elderly patients who underwent successful MT, only one achieved good functional outcome, and most died in the setting of WoLST. These observations may raise the question about the appropriateness of MT in this cohort, emphasizing the need for further research aimed (1) to identify determinants of outcome and MT success specific to elderly MT candidates and (2) to better understand the process of clinical decision making for this growing, vulnerable population of elderly patients.
