This is a retrospective study collecting patients with acute ischemic stroke treated in a single stroke center between 2005 and 2009. A total of 2254 patients were collected. The data were stratified in 2 age groups to define elderly: younger group, <75 (n=1190) or older group, ≥75 (n=1064). Endovascular treatment was performed under institutional criteria in 70 cases in younger group and 37 cases in older group.

No significant difference in medication taken between groups. The older group has higher incidence of hypertension and atrial fibrillation. The median baseline modified Barthel Index (mBI) was significantly lower in older group (20 vs. 19).

Recanalization was achieved equally in between groups (68% vs. 79%).

The immediate outcome measured by decreasing in NIHSS score ≥4 showed non-significance between groups (70% vs. 82%). Significant worse in symptomatic intracranial hemorrhage (ICH) and in-hospital mortality was observed in older group (9% vs. 24% and 26% vs. 46%, respectively). The long-term outcome measured by mBI ≥15 revealed significant inferior in older group (51% vs. 28% at 3 months and 52% vs. 22% at 1 year, p<0.05).

These findings indicate limitation in endovascular treatment in elderly patients. Pretreatment condition is usually worse than younger patient. Significant risks of symptomatic ICH and mortality are the main concern. Additionally, less improvement of neurological function in elderly is a known issue. Angiographic outcome alone is not sufficient to satisfy the patients and relatives.