There is no upper age limit for thrombectomy in Ireland.

Thrombectomy, the mechanical removal of blood clots in acute stroke, is an increasingly important treatment for stroke that can also benefit the very old (aged over 80) – assuming a careful selection of patients and risk assessment. However, it is not without risks. This is a finding of a Portuguese study presented at the 4th Congress of the European Academy of Neurology (EAN) which took place in Lisbon this week (16-19 June).

According to Dr Ary Lopes de Sousa (Lisbon), one of the authors of the study, “more and more study results show the high effectiveness of mechanical removal of blood clots after a stroke. But researchers are still trying to determine the type of patient for whom this relatively new procedure is the best treatment option.”

Therefore, Dr Ary de Sousa and his colleagues reviewed the treatment success of thrombectomy in more than 200 patients who had suffered an acute ischaemic stroke and had no or only slight disability prior to their stroke. The patients were divided into two groups: one with people aged under 80 and another with individuals aged 80 and older.

According to the findings, one third of the elderly patients aged 80 and older were functionally independent after the procedure.

In the group of elderly patients age 80 and older hypertension was more frequent as were transitory ischemic attacks (TIAs), a type of impaired circulation in the brain that leads to short-term neurological complaints.

The actual treatment did not differ for the two groups. However, in the older group, two thirds of the patients exhibited a poor functional outcome at three months after the treatment, i.e. they were moderately or severely limited in their ability to handle their daily tasks.

The number of impaired individuals was substantially larger in the older group compared to the younger, where just under half (46 per cent) faced limitations in their everyday lives.

On the other hand, one third of the patients age 80 and older were able to handle their everyday lives three months after the treatment with no or mild impairments from the stroke.

No difference was observed between the two age groups in terms of death.

According to Dr Ary de Sousa, “For patients over 80, thrombectomy appears to be riskier than for younger patients. But one third of the patients over 80 can be fully functional in their everyday lives after the procedure, so we must identify the factors associated with this favorable outcome. This will support us applying this modern procedure efficiently to those individuals among the very old who can benefit from it.”

Dr John Thornton is a consultant interventional neuroradiologist at Beaumont Hospital in Dublin and the Director of the National Thrombectomy Service in Ireland.

Speaking to the Irish Heart Foundation, Dr Thornton said that there was no upper age limit for someone to be eligible for a thrombectomy in Ireland and that he had successfully carried out the procedure on a patient aged 96.

“Randomised trials have shown that although certain subgroups such as the elderly may not do as well as younger patients, they still have a definite benefit in having thrombectomy versus not having it and that is why we have no upper age limit,” Dr Thornton explained.

However, he advised that If an elderly patient was unwell with severe medical comorbidities before they suffered the stroke it would seem inappropriate to proceed with thrombectomy.

Like any other medical treatment, he said, when deciding whether or not to treat the very old with thrombectomy, it was important to consider the potential benefits and to ensure treating the patient would improve their quality of life.

ENDS