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. 2025 Jun;10(2):371-378.
doi: 10.1177/23969873241299335. Epub 2024 Nov 20.

Stroke thrombectomy in the elderly: A propensity score matched study on a nationwide real-world registry

Michele Romoli  1 , Ludovica Migliaccio  2 , Valentina Saia  3 , Giovanni Pracucci  4 , Luigi Cirillo  5   6 , Stefano Forlivesi  2 , Daniele Romano  7 , Ilaria Casetta  8 , Enrico Fainardi  9 , Fabrizio Sallustio  10 , Nicola Limbucci  11 , Patrizia Nencini  12 , Valerio Da Ros  13 , Marina Diomedi  14 , Stefano Vallone  15 , Guido Bigliardi  16 , Sergio Lucio Vinci  17 , Paolino La Spina  18 , Mauro Bergui  19 , Paolo Cerrato  20 , Sandra Bracco  21 , Rossana Tassi  22 , Andrea Saletti  23 , Cristiano Azzini  24 , Maria Ruggiero  25 , Lucio Castellan  26 , Tiziana Benzi Markushi  27 , Roberto Menozzi  28 , Alessandro Pezzini  29 , Guido Andrea Lazzarotti  30 , Nicola Giannini  31 , Davide Castellano  32 , Andrea Naldi  33 , Alessio Comai  34 , Elisa Dall'Ora  35 , Mauro Plebani  36 , Manuel Cappellari  37 , Giulia Frauenfelder  38 , Edoardo Puglielli  39 , Alfonsina Casalena  40 , Nicola Burdi  41 , Giovanni Boero  42 , Sergio Nappini  43 , Nicola Davide Loizzo  44 , Nicola Cavasin  45 , Adriana Critelli  46 , Diego Ivaldi  47 , Tiziana Tassinari  3 , Francesco Biraschi  48 , Ettore Nicolini  49 , Sergio Zimatore  50 , Marco Petruzzellis  51 , Pietro Filauri  52 , Berardino Orlandi  53 , Ivan Gallesio  54 , Delfina Ferrandi  55 , Marco Pavia  56 , Paolo Invernizzi  57 , Pietro Amistá  58 , Monia Russo  59 , Adriana Paladini  60 , Annalisa Rizzo  61 , Michele Besana  62 , Alessia Giossi  63 , Marco Filizzolo  64 , Marina Mannino  65 , Salvatore Mangiafico  66   67 , Danilo Toni  49 , Andrea Zini  2
Affiliations

Stroke thrombectomy in the elderly: A propensity score matched study on a nationwide real-world registry

Michele Romoli et al. Eur Stroke J. 2025 Jun.

Abstract

Introduction: Data on safety and efficacy of endovascular thrombectomy (EVT) for acute ischemic stroke in older patients are limited and controversial, and people aged 80 or older were under-represented in randomized trials. Our aim was to assess EVT effect for ischemic stroke patients aged ⩾80 at a nationwide level.

Patients and methods: The cohort included stroke patients undergoing EVT from the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS). Patients were a priori divided into younger and older groups (<80 vs ⩾80). Primary outcome was good functional outcome (modified Rankin scale, mRS, 0-2 at 90 days). Secondary outcomes were symptomatic intracranial hemorrhage (sICH), successful reperfusion, EVT abortion. Propensity score matching (PSM) was performed between age groups for baseline features, functional status, stroke severity and neuroradiological features. Logistic regression was implemented to test the weight of age group on the predefined outcomes.

Results: Overall, 5872 individuals (1:1 matching, n = 2936 aged ⩾80 vs n = 2936 < 80) were matched from 13,922 records. In ⩾80 group 34.1% had good functional outcome, vs 51.2% in <80 group (absolute difference = -17.1%, p < 0.001), with a 4.4% excess in EVT abortion. Age ⩾80 was a negative independent predictor of good functional outcome (aOR = 0.4, 95% CI = 0.3-0.5), but had no impact on sICH.

Discussion and conclusion: Age ⩾80 years represents a consistent predictor of worse functional outcome, independently from successful reperfusion and sICH. Cost-effectiveness studies are needed for tailored and implement sustainable care, and research should focus on strategies to improve functional outcome in older age patient groups.

Keywords: Thrombectomy; aging; elderly; ischemic stroke; older population.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: MR declares support for educational activities from CLS-Behring and PRESTIGE-AF trial. SN declares consulting fees from Medtronic, Cerenovus, Stryker, and Balt. MC declares consultancy or advisory board fees or speaker’s honoraria from Pfizer/Bristol Meyer Squibb and Daiichi Sankyo. AZ received speaker and consultation fees from Alexion, CLS-Behring, Boehringer-Ingelheim. All the other authors report no disclosures.

Figures

Graphical abstract
Graphical abstract
Figure 1.
Figure 1.
Flowchart for cohort selection and matching.
See this image and copyright information in PMC

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