Selection criteria and efficacy of endovascular thrombectomy in the elderly in recent trials
| Trial | Inclusion criteria | Mean age in elderly group (range) | N ET arm in >80 (total >80) | RR/OR (95% CI) | Significant |
| MR CLEAN | Age ≥18, within 6 hours of onset, NIHSS ≥2, occlusion of ICA, M1/2, A1/2 | NR (80+) | NR (81) | 3.24 (1.22 to 8.62) | Yes |
| ESCAPE | Age ≥18, within 12 hours of onset, ASPECT ≥6, pre-stroke Barthel Index ≥90, occluded ICA or M1/M2 | NR (80+) | 46 (85) | 2.06 (0.95 to 4.45) | No |
| SWIFT-PRIME | Age 18–80, within 4.5 hours of onset (+IV tPA), pre-stroke mRS <2, NIHSS 8–29, occlusion of ICA, M1/M2 | Excluded* (70–80) | Excluded* | For age 70+: 1.78 (1.03 to 3.09) | Yes* |
| EXTEND-IA | Age ≥18, within 6 hours of onset, pre-stroke mRS <2, occlusion of ICA, M1/M2, core lesion <70 mL | NR (80+) | NR | No age stratification | NR |
| REVASCAT | Age 18–80, within 8 hours of onset, NIHSS ≥6, ASPECT ≥6, occluded ICA or M1 | Excluded† (70–85) | Excluded† | For age 70+: 0.9 (0.4 to 2.0) | No |
| THRACE | Age 18–80, within 4 hours of onset, NIHSS 10–25, pre-stroke mRS <2, occluded ICA, M1, or basilar | Excluded* (70–80) | Excluded* | For age 70+: 1.54 (0.81 to 2.93) | No |
| DAWN | Age ≥18, within 6–24 hours of onset, NIHSS ≥10, pre-stroke mRS <2, occlusion of ICA, M1, infarct volume <21 mL | NR (80+) | 25 (29) | 2.3 (0.3 to 4.2) | Yes |
↵*Patients >80 years of age excluded. Data from patients in the 70–80 group analyzed in the trial
↵†Trial later amended to include 80–85 year old patients, but analysis is for patients above 70.
DAWN, Diffusion Weighted Imaging or Computerized Tomography Perfusion Assessment with Clinical Mismatch in the Triage of Wake Up and Late Presenting Strokes Undergoing Neurointervention with Trevo; ESCAPE, Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion with Emphasis on Minimizing CT to Recanalization Times; EXTEND-IA Extending the Time for Thrombolysis in Emergency Neurological Deficits-Intra-Arterial; MR CLEAN, Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands; REVASCAT=Randomized Trial of Revascularization with Solitaire FR Device vs Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting within Eight Hours of Symptom Onset; SWIFT PRIME, Solitaire With the Intention For Thrombectomy as Primary Endovascular Treatment; THRACE, Trial and Cost Effectiveness Evaluation of Intra-arterial Thrombectomy in Acute Ischemic Stroke.
ASPECT score, Alberta Stroke Program Early CT score; ICA, internal carotid artery; IV tPA, intravenous tissue plasminogen activator; mRS, modified Rankin Scale; NIHSS, National Institutes of Health Stroke Scale.