Six recent phase 3 randomized clinical trials (RCTs) and current aggregate-data meta-analyses have provided robust evidence that endovascular thrombectomy (EVT) in addition to best medical treatment (BMT) compared with best BMT alone is associated with improved functional outcomes among patients with large vessel occlusion (LVO) with large core Alberta Stroke Program Early Computed Tomography Score (ASPECTS) 0 to 5 acute ischemic stroke (AIS). [1][2][3][4][5] More specifically, a recent meta-analysis of 6 RCTs 5 documented that EVT compared with BMT increased the likelihood of good functional outcome (modified Rankin Scale [mRS] score of 0-2) and excellent functional outcome (mRS score of 0-1) by more than 2-fold at 3 months. EVT was also independently associated with increased rates of independent ambulation (mRS score of 0-3) and the odds of reduced disability (mRS shift analysis). 5 There was an independent increase in the risk of symptomatic intracranial hemorrhage (sICH) with EVT, while mortality tended to be lower in the EVT-treated subgroup, although the result was not statistically significant (16% relative risk reduction; P = .06). 5 However in these RCTs, patients older than 80 years were underrepresented (in TENSION, SELECT 2, and TESLA), selected more stringently (in LASTE), or even fully excluded (in ANGEL-ASPECT). The treatment effect of EVT in older patients (>80 years) with AIS, LVO, and ASPECTS 6 to 10 has been previously established in an individual patient-data meta-analysis conducted by Highly Effective Reperfusion evaluated in Multiple Endovascular Stroke Trials (HERMES) investigators. 6 Moreover, predefined subgroup analyses of these 6 pivotal RCTs did not provide evidence that age represents an effect modifier of the efficacy of EVT (compared with BMT) in patients with AIS with large ischemic core. [1][2][3][4][5] On the other hand, data on EVT safety and efficacy in the oldest-old patients with established large infarct remain scarce, despite the fact that this subgroup is frequently encountered in acute stroke treatment.In view of the former considerations, the German Stroke Registry-Endovascular Treatment (GSR-ET) investigators conducted a retrospective analysis of prospectively collected (during a 7-year period) observational data in patients with anterior circulation LVO (isolated occlusion of intracranial internal carotid artery and M1 middle cerebral artery) with established large infarct (ASPECTS 0-5). 7 They compared safety and efficacy outcomes in 126 patients older than 80 years and 282 patients aged 80 years and younger. 7 The rate of independent ambulation decreased from 56.4% in patients 60 years and younger to 15.1% in patients older than 80 years (P < .001), while mortality increased from 15.4% to 64.3% (P < .001). Consistent with most other stroke studies, being older than 80 years was associated with lower rates of independent ambulation (adjusted odds ratio, 0.44; 95% CI, 0.23-0.82) and higher mortality (adjusted odds ratio, 2.75; 95% CI, 1.61-4.72). However, successful r...
