E-077 Thrombectomy in elderly stroke patients presenting with low ASPECTS: insights from STAR registry

Background Four recent randomized controlled trials demonstrated the efficacy and safety of mechanical thrombectomy (MT) for large vessel occlusion acute ischemic strokes (LVO-AIS) patients presenting with low Alberta Stroke Program Early CT Score (ASPECTS). However, these trials included very few patients aged over 80 years. In this study we aim to investigate whether elderly ischemic LVO-AIS patients with low ASPECTS benefit from MT. Methods This study used the data from the Stroke Thrombectomy and Aneurysm Registry (STAR), a prospectively maintained database of 49 thrombectomy-capable stroke centers in the US, Europe, and Asia between 2013 and 2023. LVO-AIS patients ≥ 80-year-old presenting with ASPECTS ≤ 5, who underwent MT for internal carotid artery (ICA), M1, or M2 segments of middle cerebral artery (MCA) occlusion. The primary outcome was 90-day favorable outcomes, defined as modified Rankin Scale [mRS] score of 0–3. Secondary outcomes included modified Thrombolysis in Cerebral Ischemia (mTICI) score, 90-day mortality and symptomatic intracranial hemorrhage (sICH). Results Among the 10,229 patients who underwent mechanical thrombectomy, 101 met the inclusion criteria. Successful recanalization was achieved in 81 (80.2%) of patients. 19 (18.8%) patients experienced 90-day favorable outcomes, with 8 (7.9%) achieving an mRS score of 0–2. sICH occurred in 14 (13.9%) patients, and the 90-day mortality rate was 49.5%. Only 1 patient (5.6%) ≥ 90 years achieved a favorable outcome at 90 days, while 11 patients (21.2%) aged 80–84 years and 7 patients (22.5%) aged 85–89 did. Among all patients aged ≥ 80 years, multivariate analysis identified higher ASPECTS (aOR, 1.21; 95% CI, 1.09 - 1.35; p < 0.001) as a predictor of 90-day favorable outcome, but it is not associated with 90-day mortality (aOR, 1.02; 95% CI, 0.93 - 1.12; p = 0.70). Conclusion Our study highlights the efficacy and safety of mechanical thrombectomy for elderly patients aged ≥ 80 years presenting with low ASPECTS. However, for individuals aged ≥ 90 years, the decision to proceed with thrombectomy should be carefully considered on a case-by-case basis. Disclosures Z. Hubbard: None. C. Cunningham: None. S. Elawady: None. R. Abo Kasem: None. J. Isidor: None. H. Matsukawa: None. I. Maier: 3; C; speakers honoraria from Pfizer and Bristol-Myers Squibb. P. Jabbour: None. J. Kim: None. S. Quintero Wolfe: None. A. Rai: None. R. Starke: 1; C; RMS research is supported by the NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, Department of Health Biomedical Research Grant (21K02AWD-007000) and by National Institute of H. M. Psychogios: 1; C; Grants from the Swiss National Science Foundation (SNF) for the DISTAL trial (33IC30_198783) and TECNO trial (32003B_204977), Grant from Bangerter-Rhyner Stiftung for the DISTAL trial. Unrestricted Gr. E. Samaniego: 2; C; consults for Medtronic, microvention, Rapid Medical. N. Goyal: None. S. Yoshimura: 3; C; lecture fee from Stryker, Medtronic, Johnson & Johnson, Kaneka Medics. H. Cuellar: 2; C; Consultant for Medtronic and Microvention. J. Grossberg: 1; C; Georgia Research Alliance, Emory Medical Care Foundation, Neurosurgery Catalyst,. 2; C; Consultant: Cognition, Imperative Care. A. Alawieh: None. A. Alaraj: 2; C; Consultant for Cerenovus. M. Ezzeldin: 2; C; Consultant for Viz.ai and Imperative care. 4; C; Investments in Galaxy Therapeutics. D. Romano: 2; C; Consultant for Penumbra, Balt, Microvention, Phenox. O. Tanweer: 1; C; Consulting Agreements: Viz.AI, Inc., Penumbra, Inc, Balt, Inc, Stryker Inc, Imperative Inc. J. Mascitelli: None. I. Fragata: None. A. Polifka: None. F. Siddiqui: None. J. Osbun: None. R. Grandhi: 2; C; Consultant for Balt Neurovascular, Cerenovus, Medtronic Neurovascular, Rapid Medical, and Stryker Neurovascular. R. Crosa: None. C. Matouk: 1; C; Contact PI for NIH Grant R21NS128641. 2; C; Consultant for Stryker, Medtronic, Microvention, Penumbra, and Silk Road Medical. 3; C; Speaker for Penumbra and Silk Road Medical. M. Park: 2; C; Medtronic. M. Levitt: 1; C; Unrestricted educational grants from Medtronic and Stryker. 2; C; consulting agreement with Medtronic, Aeaean Advisers and Metis Innovative. 4; C; equity interest in Proprio, Stroke Diagnostics, Apertur, Stereotaxis, Fluid Biomed, and Hyperion Surgical. W. Brinjikji: 2; C; Medtronic, Stryker, Imperative Care, Microvention, MIVI Neurovascular, Cerenovus, Asahi, and Balt. 4; C; Nested Knowledge, Superior Medical Editors, Piraeus Medical, Sonoris Medical, and MIVI Neurovascular. M. Moss: None. E. Daglioglu: None. R. Williamson Jr.: 2; C; Consultant for Medtronic, Stryker, and Synaptive Medical. P. Navia: 2; C; Consultant for Penumbra, Medtronic, Stryker, Cerenovus and Balt. P. Kan: 1; C; Grants from the NIH (1U18EB029353–01) and unrestricted educational grants from Medtronic and Siemens. 2; C; Consultant for Imperative Care and Stryker Neurovascular. 4; C; Stock ownership in Vena Medical. R. De Leacy: 1; C; Research grants from Siemens Healthineers and Kaneka medical. 2; C; Consultant for Cerenovus, Stryker Neurovascular and Sim & Cure. 4; C; Minor equity interest Vastrax, Borvo medical, Synchron, Endostream, Von Vascular, Radical catheters and Precision Recovery Inc. S. Chowdhry: 2; C; Consultant and proctor for Medtronic and Microvention. D. Altschul: 1; C; Research Support The Bee Foundation. 2; C; Consultant for MicroVention, Stryker, Q’apel, Synchron, and Cerenovus. 4; C; Investor Von Vascular,. A. Spiotta: 2; C; Consultant for Penumbra, Terumo, RapidAI, Cerenovus.

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