INTRODUCTION Mechanical thrombectomy (MT) is recommended for large vessel occlusion (LVO) stroke. However, most of the studies that investigated the superiority of MT over best medical management (BMM) alone included preponderantly non-elderly patients. Thus, there is uncertainty in relation to the efficacy of MT in the elderly. We aim to compare the effect of BMM to BMM plus (MT) among elderly and non-elderly patients with (LVO). METHODS We performed a systematic search of medical databases from inception to April 2023 to identify randomized studies that reported the functional outcome at 90 days by age for patients with LVO treated with MT vs. BMM. Patients were divided into elderly (>70 or >80 years, depending on the cut-off used in each study) and non-elderly. Outcomes were defined as excellent (modified Rankin Scale [mRS]≤1), good (mRS≤3), poor (mRS≥5), or death. Effect sizes were calculated by using random effects meta-analyses. Results were represented by odds ratio (OR) and their 95% confidence intervals (95% CI). RESULTS A total of 2,195 patients were included in the analysis (≥70 years, 7 trials, n= 696; ≥80 years, 2 trials, n=139). Non-elderly patients treated with MT had higher odds of excellent outcome (OR 3.05; 95% CI 2.23-4.18) and good outcome (OR 2.70; 95% CI 1.94-3.74), and lower odds of poor outcome (OR 0.54; 95% CI 0.40-0.72) and death (OR 0.63; 95% CI 0.41-0.96). Similarly, elderly patients treated with MT had higher odds of excellent (OR 2.39; 95% CI 1.05-5.45) and good outcomes (OR 2.18; 95% CI 1.43-3.33) and lower odds of poor outcome (OR 0.48; 95% CI 0.33-0.70) and mortality (OR 0.50; 0.26-0.95). When outcomes were analyzed by age subgroups, MT was associated with higher odds of good outcome in patients ≥70 years (OR 1.95, 95% CI 1.26-3.03) and ≥80 years (OR 4.43, 95% CI 1.02-19.23). DISCUSSION/CONCLUSION MT increases the likelihood of achieving a good outcome in elderly and non-elderly patients without increasing the risk of severe disability or death. MT, when otherwise clinically indicated, should be considered over BMM alone in both age groups.

中文翻译：

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机械血栓切除术对老年和非老年大血管闭塞中风患者的疗效和安全性系统评价和荟萃分析。

简介 对于大血管闭塞 (LVO) 卒中，建议采用机械取栓术 (MT)。然而，大多数研究 MT 相对于单独最佳医疗管理 (BMM) 的优越性的研究主要包括非老年患者。因此，MT 对老年人的疗效存在不确定性。我们的目的是比较 BMM 与 BMM plus (MT) 在老年和非老年 (LVO) 患者中的效果。方法 我们对从成立到 2023 年 4 月的医学数据库进行了系统检索，以确定报告接受 MT 与 BMM 治疗的 LVO 患者 90 天时功能结果的随机研究。患者被分为老年人（>70 岁或>80 岁，具体取决于每项研究中使用的截止值）和非老年人。结果定义为优秀（改良Rankin量表[mRS]≤1）、良好（mRS≤3）、差（mRS≥5）或死亡。通过使用随机效应荟萃分析来计算效应大小。结果以比值比 (OR) 及其 95% 置信区间 (95% CI) 表示。结果 分析共纳入 2,195 名患者（≥70 岁，7 项试验，n= 696；≥80 岁，2 项试验，n=139）。接受 MT 治疗的非老年患者获得优异结局（OR 3.05；95% CI 2.23-4.18）和良好结局（OR 2.70；95% CI 1.94-3.74）的几率较高，而不良结局的几率较低（OR 0.54；95） % CI 0.40-0.72）和死亡（OR 0.63；95% CI 0.41-0.96）。同样，接受 MT 治疗的老年患者获得优异结局（OR 2.39；95% CI 1.05-5.45）和良好结局（OR 2.18；95% CI 1.43-3.33）的几率较高，而不良结局的几率较低（OR 0.48；95% CI）。 0.33-0.70）和死亡率（OR 0.50；0.26-0.95）。当按年龄亚组分析结果时，MT 与≥70 岁（OR 1.95，95% CI 1.26-3.03）和≥80 岁（OR 4.43，95% CI 1.02-19.23）的患者良好结局的几率较高相关。讨论/结论 MT 增加了老年和非老年患者获得良好结果的可能性，而不增加严重残疾或死亡的风险。在两个年龄组中，当有其他临床指征时，应考虑 MT 而非单纯 BMM。