Mechanical thrombectomy for elderly stroke patients: An updated systematic review and meta-analysis of randomized clinical trials

Background: Although multiple clinical trials have established the efficacy of mechanical thrombectomy (MT) in managing acute ischemic stroke (AIS) in the general population, its outcomes specifically in elderly patients remain uncertain. This study aims to evaluate the efficacy and safety of MT in elderly patients with AIS, providing a clearer understanding of its potential benefits in this population. Methods: We searched PubMed, Embase, and Cochrane databases for randomized clinical trials (RCTs) comparing MT with standard medical management in patients with AIS, with data available for elderly patients (over 70 years). Outcomes included functional recovery (≥1-point mRS improvement), excellent (mRS 0–2), good (mRS 0–3), poor (mRS ≥5) outcomes, and mortality at 90 days. Pooled odds and risk ratios (OR and RR) with 95% confidence intervals (CIs) were estimated using a random-effects model. Results: Fifteen RCTs, involving 1481 elderly patients, were included. MT was associated with a better functional recovery (OR 1.54; 95% CI: 1.22–1.94; P < .01), higher rates of excellent (RR 1.60; 95% CI: 1.11–2.30; P = .01) and good (RR 1.84; 95% CI: 1.45–2.35; P < .01), and lower rates of poor functional outcomes (RR 0.71; 95% CI: 0.58–0.85; P < .01) and mortality (RR 0.65; 95% CI: 0.45–0.96; P = .03). Subgroup analyses based on age threshold (>80 years), anterior/posterior circulation, and country socioeconomic status were consistent with the overall results. Conclusions: This updated meta-analysis suggests that MT may be associated with better functional outcomes and lower mortality in selected elderly patients with AIS; however, limited elderly specific safety data and selective trial populations warrant cautious interpretation. © The Author(s) 2026