Jinrui Li,1,2,* Junting Chen,3,4,* Kailin Cheng,3,5 Jianxia Ke,1,5 Jintao Li,1,5 Jia Wen,3,5 Xiaoli Fu,1,5,* Zhu Shi1,3,5,* 

1Department of Neurology and Stroke Center, Dongguan People’s Hospital, Southern Medical University, Dongguan, Guangdong, People’s Republic of China; 2Department of Neurology, Nanyang Central Hospital, Henan Province, Nanyang, Henan, People’s Republic of China; 3Postgraduate School, Guangdong Medical University, Zhanjiang, Guangdong, People’s Republic of China; 4Department of Neurology, Houjie Hospital, Guangdong Medical university, Dongguan, Guangdong, People’s Republic of China; 5Department of Neurology, The 10th Affiliate Hospital, Southern Medical University, Dongguan, Guangdong, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Xiaoli Fu, Email cocofuxiaoli@163.com; Zhu Shi, Email sound_shi@126.com

Background: Current guidelines have not recommended an upper age limit for endovascular thrombectomy (EVT) in patients with large vessel occlusion (LVO) stroke. However, elder age links to an increased risk of poor outcome. This study aimed to investigate the efficacy of EVT in elderly versus non-elderly patients and determine the respective factors of poor outcome.
Methods: Three hundred and two consecutive patients with LVO-stroke who underwent EVT were included, and we used sensitivity analysis with restricted cubic spline to define 75 years as the inflexion point. Participants were thus dichotomized into elderly (≥ 75 years) and non-elderly (< 75 years) groups. Brain frailty on neuroimaging was evaluated using the global cortical atrophy (GCA) scale and the Fazekas scale for white matter lesions (WML). The primary outcome was 3-month functional outcome, and the secondary outcomes were EVT efficacy and safety.
Results: Elderly patients had significantly higher incidences of hypertension, diabetes mellitus, atrial fibrillation, and more severe GCA and WML. The rate of good outcome in elderly patients was 32%, significantly lower than non-elderly patients (54%, p< 0.001). There was no difference in terms of reperfusion (89% vs 93%, p=0.363) and intracranial hemorrhage (38% vs 41%, p=0.826) between two groups. In elderly patients, high degree of GCA (OR 1.15, 95% CI 1.02– 1.30, p=0.012) and moderate/severe WML (OR 5.88, 95% CI 1.47– 23.50, p=0.015) independently predicted 3-month poor outcomes.
Conclusion: GCA and WML play pivotal roles for the functional outcomes in elderly patients undergoing EVT for LVO-stroke, providing valuable and practical information for early prediction of long-term prognosis.

Keywords: stroke, endovascular thrombectomy, prognosis, elderly, brain frailty