Background Frailty is a complex syndrome, referring to a state of increased vulnerability from age-associated decline that has been quantified by various validated scales. While frailty has been associated with an increased risk of adverse outcomes and reduced tolerance to open neurosurgical interventions, the overall safety and efficacy of mechanical thrombectomy (MT) for acute ischemic stroke (AIS) in frail patients is not well delineated. This systematic review aims to summarize and compare outcomes in frail and non-frail patients who underwent MT for AIS.

Methods A systematic review of literature was performed using Pubmed, Ovid Medline, and Web of Science. Studies with outcomes-related data patients with MT-treated AIS and with pre-stroke validated frailty score (ie. Clinical Frailty Scale, Hospital Frailty Risk Score, or Frailty Index) were included. Baseline patient and AIS characteristics, recanalization rate, procedural complications, and clinical outcome at 90-day follow-up for frail and non-frail patients were collected.

Results In the four included studies, there were 642 frail patients and 499 not frail patients. Frail patients had higher NIHSS on admission [16.3(2.5) versus 15.7(0.6), t=5.16, p<0.01] and were more likely to present with anterior circulation occlusions [97% versus 88%, X²=42, p<0.01] compared to their non-frail counterparts. Frail patients experienced reduced rates of successful recanalization [72% versus 80%; X²=4.6, p=0.03], reduced rates of good functional outcomes [29% versus 42%; X²=22, p<0.01], and increased 90-day mortality [51% versus 25%; X²=38, p<0.01] compared to non-frail patients.

Conclusion MT for treatment of AIS in frail patients is associated with worse rates of morbidity and mortality along with reduced efficacy. More studies are needed to further evaluate and identify characteristics that may be more favorable to endovascular management in these patients.

Disclosures N. Dabhi: None. J. Kumar: None. R. Kellogg: None. M. Park: None.