Prognostic determinants of anterior large vessel occlusion in acute stroke in elderly patients

Introduction Mechanical thrombectomy(MT) has been shown to be safety and effectiveness for acute anterior circulation large vessel occlusion(LVO)of all ages, and together with intravenous thrombolysis has become an standard treatment for acute stroke. In an aging world, the effectiveness of MT for the elderly has not been fully demonstrated. We investigated factors associated with prognosis in elderly patients undergoing MT in Japanese practice, where the elderly are defined as those aged 80 years or older, in the context of an ageing population. Method MT was performed in 59 cases of LVO of the anterior circulation. Primary outcome evaluated functional outcome at three months. Parametric and/or non-parametric test and a binomial logistic regression model was performed to identify prognosis factors in elderly patients. Results Overall, Of the 59 patients, 47.5% (28/59) achieved an mRS ≤3 at 3 months. Mortality rate was 20.3% (12/59). Younger age( P =0.032), lower NIHSS on admission( P =0.00005), lower level of NT-proBNP on admission( P =0.041), lower level of D-dimer on admission( P =0.01), First Pass Effect (FPE) ( P =0.024) and good recanalization( P =0.0025) were associated with favorable clinical outcome. In the binomial logistic regression model, only lower NIHSS on admission was significantly associated with good clinical outcome. Conclusions In the present study, not only were younger age, lower NIHSS on admission and FPE already reported as prognostic factors for MT for LVO in the elderly, but also, although not previously reported, lower levels of NT-proBNP on admission and lower level of D-dimer on admission were considered as possible prognostic factors. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement JSPS KAKENHI Grant Numbers 21K18443 ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: In this retrospective single-center study, the protocol was approved by the ethics committee of Juntendo University Nerima Hospital. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes