Age matters in treating stroke patients with stent-retriever surgery

This study looked at whether stent-retriever surgery to remove blood clots from patients suffering from stroke should be performed on patients of all ages. 

A stroke occurs when there is a disturbance of oxygen supply to a part of the brain. Most of the time, a stroke is caused by a blood clot (thrombus) in a blood vessel, called an ischemic stroke.

Strokes can be treated using mechanical thrombectomy, also known as stent-retriever surgery. This operation involves inserting a small catheter (small flexible tube) into a blood vessel, usually in the groin area, which is then passed along the blood system to the blocked blood vessel in the brain. At this point, a wire mesh stent is released inside the blood vessel, which captures the blood clot and is used to pull the blood clot out of the body.

There are many different types of stents that can be used to remove blood clots. One such stent is the new Solitaire FR stent. Recently, mechanical thrombectomy with this stent has been shown to successfully remove blood clots and restore blood flow to the brain. However, it is not known if it is safe in older patients.

This study investigated whether the mechanical thrombectomy with the Solitaire FR stent is safe and effective at removing blood clots in younger and older patients with ischemic stroke.

A total of 354 patients underwent treatment with the Solitaire FR stent to remove blood clots that were causing an ischemic stroke; 276 patients were aged <80 years and 78 were >80 years of age. Average age in the <80 group was 62 years, and average age in the >80 group was 85 years. 

The study found that at 90 days after the operation, 27% of patients aged <80 years had passed away, compared to nearly half (44%) of patients that were aged >80 years. Similarly, 45% of younger patients had good functional outcome with slight or no disability caused by the stroke, whereas, only 27% of older patients had good functional outcome. 

The investigators concluded that mechanical thrombectomy with the Solitaire FR stent is associated with worse survival and outcome in patients aged over 80 years. 

Mechanical thrombectomy with the Solitaire FR stent may suit carefully selected ischemic stroke patients aged >80 years. For example, older patients that have received tissue-type plasminogen activator (a drug used to dissolve blood clots), have only mild stroke symptoms, and who are treated soon after stroke onset. 

If you are at a high risk of having a stroke, talk to a doctor about the different treatments available to remove blood clots.