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In elderly AIS patients, BT and DMT showed comparable outcomes, with CRP and puncture time predicting prognosisComparison of two stroke treatments shows similar outcomes in older patients

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Key Takeaway
Consider using time to puncture, NIHSS, and CRP to predict poor outcomes in elderly AIS patients undergoing thrombectomy.

This single-center retrospective study evaluated 87 patients aged 75 years and older with acute ischemic stroke (AIS) who underwent either bridging thrombectomy (BT) or direct mechanical thrombectomy (DMT). The analysis was conducted at Liuan City Hospital of Traditional Chinese Medicine and utilized propensity score matching to balance baseline characteristics between the two groups. The primary outcome was 90-day functional status, while secondary outcomes included neurological metrics, inflammatory markers, and complication rates at 24 hours, 7 days, and 90 days.

Analysis of inflammatory markers revealed that C-reactive protein (CRP) levels on day 7 were significantly higher in the BT group compared to the DMT group (P = 0.008). Regarding functional prognosis, independent predictors for poor 90-day outcomes included time to puncture, NIHSS scores at 24 hours, and CRP levels at 7 days. Specifically, a pre-puncture time exceeding 3.25 hours was associated with a 6.36-fold higher risk of poor outcome, while an NIHSS greater than 14.5 at 24 hours correlated with a 2.22-fold increased risk. A predictive model incorporating these variables demonstrated high accuracy with an AUC of 0.93.

The study did not report specific adverse events, serious adverse events, discontinuations, or tolerability data. Consequently, a direct safety comparison between BT and DMT cannot be established from this evidence. The authors note that the developed model may serve as a reliable tool for individualized prognosis assessment and optimization of treatment strategies in elderly stroke patients. However, the retrospective nature of the study and the single-center setting limit the generalizability of these findings to broader clinical populations.

This study looked at patients aged 75 and older who had acute ischemic stroke and received either bridging thrombectomy or direct mechanical thrombectomy. The team analyzed data from 87 patients treated at Liuan City Hospital of Traditional Chinese Medicine to compare their recovery over 90 days. They also checked neurological scores and inflammatory markers like CRP to see how these factors affected outcomes.

The main finding was that both treatment methods produced comparable short-term and long-term results. However, the researchers identified specific factors that predicted a poorer outcome. These included a longer time to puncture, higher NIHSS scores at 24 hours, and elevated CRP levels at seven days. A predictive model using these factors showed high accuracy in forecasting patient status.

No safety concerns or adverse events were reported in this group of patients. While the results are promising for elderly stroke patients, the study was conducted at a single center with a limited number of participants. Readers should understand that this early evidence does not prove one method is superior, and larger studies are needed to confirm these findings before changing standard treatment strategies.

What this means for you:
Both stroke treatments showed similar outcomes in older patients, but timing and inflammation levels predicted recovery.

Study Details

Study typeCohort
EvidenceLevel 3
PublishedApr 2026
View Original Abstract ↓
BackgroundAs the global population ages, the incidence of acute ischemic stroke (AIS) among individuals aged 75 years and older is steadily increasing. Mechanical thrombectomy (MT) has become a standard treatment for AIS, with two commonly employed approaches: bridging thrombectomy (BT) and direct mechanical thrombectomy (DMT). However, the efficacy and safety of these strategies in elderly patients remain inconclusive.MethodsThis single-center retrospective study included AIS patients aged 75 years and older who underwent BT or DMT at Liuan City Hospital of Traditional Chinese Medicine, affiliated with Anhui University of Traditional Chinese Medicine, between December 2020 and August 2024. After propensity score matching (PSM), patients were compared in terms of neurological outcomes (NIHSS, mRS), inflammatory markers (CRP, NLR, SII, SIRI), and complication rates at 24 h, 7 days, and 90 days post-treatment. A predictive model for 90-day functional outcome was developed using univariate and multivariate regression analyses and evaluated for performance.ResultsA total of 87 patients were enrolled, and CRP levels on day 7 after treatment were significantly higher in the BT group than in the DMT group (P = 0.008). Multivariate analysis identified time to puncture, NIHSS at 24 h, and CRP at 7 days as independent predictors of 90-day poor functional outcome. Patients with a pre-puncture time >3.25 h had a 6.36-fold higher risk of poor prognosis than those with ≤ 3.25 h. For every 1 mg/L increase in C-reactive protein at 7 days postoperatively, the risk of poor prognosis increased by 2%, with a significant risk rise when the level exceeded 28.175 mg/L. Patients with a NIHSS score >14.5 at 24 h postoperatively had a 2.22-fold higher risk of poor prognosis than those with ≤ 14.5. The predictive model demonstrated high accuracy, with an area under the curve (AUC) of 0.93. And the risk value of 0.319 is the judgment point to distinguish high and low risk groups.ConclusionIn AIS patients aged 75 years and older, both BT and DMT yielded comparable short- and long-term neurological outcomes. Onset Puncture Time, Postoperative NIHSS at 24 h and CRP at 7 days were key prognostic factors. The developed model may serve as a reliable tool for individualized prognosis assessment and optimization of treatment strategies in elderly stroke patients.
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