Treatment response to EVT among LVO stroke patients with dementia was heterogeneous, and EVT was beneficial for patients <75 years old and those with vascular dementia.
Overall home discharge rates were similar between EVT and BMM groups in dementia patients with LVO stroke.
EVT was associated with longer length-of-stay and increased intracranial haemorrhage compared to BMM.
In-hospital mortality did not significantly differ between EVT and BMM groups.
Patient age significantly moderated EVT effectiveness, with EVT associated with higher home discharge rates in patients younger than 75 years.
EVT appeared more effective for patients with vascular dementia compared to those with Alzheimer's disease.
Pre-existing dementia is a known negative predictor for good EVT outcomes, but comparative efficacy and safety data of EVT versus BMM for LVO patients with dementia were previously limited.
This research suggests that for stroke patients who also have dementia, the benefit of endovascular thrombectomy (EVT) — a procedure that physically removes the blood clot causing the stroke — depends heavily on the patient's age and type of dementia. Using a large U.S. hospital database covering 2016 to 2022, researchers compared over 19,000 dementia patients who had a large vessel occlusion stroke and received either EVT or medication-only treatment. Overall, the two groups had similar rates of being discharged home (about 27%), but EVT patients had more brain bleeding and longer hospital stays, with no difference in death rates. However, when researchers looked at specific subgroups, important differences emerged. Dementia patients younger than 75 who received EVT were significantly more likely to be discharged home (36.7% vs. 26.8%) compared to those who only received medication. Similarly, patients with vascular dementia — a type caused by reduced blood flow to the brain — benefited more from EVT than those with Alzheimer's disease, with higher home discharge rates (32.7% vs. 25.2%). This research suggests that decisions about whether to perform EVT in stroke patients with dementia should not be one-size-fits-all. Younger patients and those with vascular dementia appear to benefit from the procedure, while older patients and those with Alzheimer's disease may not see the same advantage. These findings could help clinicians and families have more informed conversations about treatment options when a dementia patient experiences a severe stroke.
Chen H, Mcintyre M, Aktay S, Yen M, Gunawardane S, Lakhani D, et al.. (2026). Endovascular thrombectomy versus medical management in patients with dementia and acute ischaemic stroke.. Age and ageing. https://doi.org/10.1093/ageing/afag241