Age Is an Effect Modifier of Thrombectomy Benefit in a Socioeconomically Vulnerable Stroke Population

RESILIENT Trial Investigators

doi:10.1002/ana.78281

Age Is an Effect Modifier of Thrombectomy Benefit in a Socioeconomically Vulnerable Stroke Population

RESILIENT Trial Investigators

Research output: Contribution to journal › Article › peer-review

Abstract

OBJECTIVE: Randomized trials from high-income countries have shown that endovascular treatment (EVT) yields similar benefits in elderly and non-elderly patients with large vessel occlusion stroke (LVOS). However, evidence from low/middle-income countries remains scarce. We aimed to assess the impact of age on outcomes and determine whether age modifies the effect of EVT under the resource-limited conditions of a public healthcare system in a developing country.

METHODS: Pre-specified subgroup analysis of the RESILIENT trial, a multicenter, randomized, controlled trial in Brazil comparing EVT versus medical treatment alone in anterior circulation LVOS. Patients were categorized as non-elderly (<70 years), elderly (≥70 years), and very elderly (≥80 years). The primary endpoint was functional independence (modified Rankin scale 0-2) at 90 days. Logistic regression was performed to identify independent predictors of outcome and to assess age as an effect modifier.

RESULTS: Among 221 randomized patients (47.1% females; median [IQR] National Institutes of Health Stroke Scale, 18 [14-21]), 89 (40.2%) were elderly and 37 (16.7%) very elderly. Increasing age was independently associated with lower odds of functional independence in the entire study population (odds ratio [OR]: 0.97; 95% confidence interval [CI]: 0.95-0.99, p = 0.01). Age significantly modified the treatment effect of EVT. Non-elderly patients derived substantial benefit from EVT (OR: 4.08; 95% CI: 1.71-9.76), whereas the benefit was attenuated in elderly (OR: 0.90; 95% CI: 0.17-5.42; p interaction = 0.03) and very elderly (OR: 0.36; 95% CI: 0.11-3.21; p interaction = 0.03).

INTERPRETATION: The effect of EVT appears significantly diminished among elderly patients in a public healthcare system in a developing country. Further studies are needed to understand the mechanism underlying these findings and properly assess the efficacy of EVT in this vulnerable population. ANN NEUROL 2026.

Original language	English
Journal	Annals of Neurology
DOIs	https://doi.org/10.1002/ana.78281
State	E-pub ahead of print - Jul 24 2026
Externally published	Yes

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10.1002/ana.78281

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@article{3ff899c319f84e1dac2e059075587278,

title = "Age Is an Effect Modifier of Thrombectomy Benefit in a Socioeconomically Vulnerable Stroke Population",

abstract = "OBJECTIVE: Randomized trials from high-income countries have shown that endovascular treatment (EVT) yields similar benefits in elderly and non-elderly patients with large vessel occlusion stroke (LVOS). However, evidence from low/middle-income countries remains scarce. We aimed to assess the impact of age on outcomes and determine whether age modifies the effect of EVT under the resource-limited conditions of a public healthcare system in a developing country.METHODS: Pre-specified subgroup analysis of the RESILIENT trial, a multicenter, randomized, controlled trial in Brazil comparing EVT versus medical treatment alone in anterior circulation LVOS. Patients were categorized as non-elderly (<70 years), elderly (≥70 years), and very elderly (≥80 years). The primary endpoint was functional independence (modified Rankin scale 0-2) at 90 days. Logistic regression was performed to identify independent predictors of outcome and to assess age as an effect modifier.RESULTS: Among 221 randomized patients (47.1\% females; median [IQR] National Institutes of Health Stroke Scale, 18 [14-21]), 89 (40.2\%) were elderly and 37 (16.7\%) very elderly. Increasing age was independently associated with lower odds of functional independence in the entire study population (odds ratio [OR]: 0.97; 95\% confidence interval [CI]: 0.95-0.99, p = 0.01). Age significantly modified the treatment effect of EVT. Non-elderly patients derived substantial benefit from EVT (OR: 4.08; 95\% CI: 1.71-9.76), whereas the benefit was attenuated in elderly (OR: 0.90; 95\% CI: 0.17-5.42; p interaction = 0.03) and very elderly (OR: 0.36; 95\% CI: 0.11-3.21; p interaction = 0.03). INTERPRETATION: The effect of EVT appears significantly diminished among elderly patients in a public healthcare system in a developing country. Further studies are needed to understand the mechanism underlying these findings and properly assess the efficacy of EVT in this vulnerable population. ANN NEUROL 2026.",

author = "\{RESILIENT Trial Investigators\} and Lima, \{Fabricio O\} and Mont'Alverne, \{Francisco Jos{\'e} de A\} and Rebello, \{Let{\'i}cia C\} and Abud, \{Daniel G\} and Silva, \{Gisele S\} and Frudit, \{Michel E\} and Wagner, \{M{\'a}rio B\} and Jamary Oliveira-Filho and Haussen, \{Diogo C\} and Liebeskind, \{David S\} and Pontes-Neto, \{Oct{\'a}vio M\} and Frota, \{Norberto A F\} and Guilherme Dabus and \{de Freitas\}, \{Gabriel R\} and \{de Lucena\}, \{Adson F\} and Saver, \{Jeffrey L\} and Nogueira, \{Raul G\} and Martins, \{Sheila C O\}",

note = "{\textcopyright} 2026 The Author(s). Annals of Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.",

year = "2026",

month = jul,

day = "24",

doi = "10.1002/ana.78281",

language = "English",

journal = "Annals of Neurology",

issn = "0364-5134",

}

TY - JOUR

T1 - Age Is an Effect Modifier of Thrombectomy Benefit in a Socioeconomically Vulnerable Stroke Population

AU - RESILIENT Trial Investigators

AU - Lima, Fabricio O

AU - Mont'Alverne, Francisco José de A

AU - Rebello, Letícia C

AU - Abud, Daniel G

AU - Silva, Gisele S

AU - Frudit, Michel E

AU - Wagner, Mário B

AU - Oliveira-Filho, Jamary

AU - Haussen, Diogo C

AU - Liebeskind, David S

AU - Pontes-Neto, Octávio M

AU - Frota, Norberto A F

AU - Dabus, Guilherme

AU - de Freitas, Gabriel R

AU - de Lucena, Adson F

AU - Saver, Jeffrey L

AU - Nogueira, Raul G

AU - Martins, Sheila C O

PY - 2026/7/24

Y1 - 2026/7/24

N2 - OBJECTIVE: Randomized trials from high-income countries have shown that endovascular treatment (EVT) yields similar benefits in elderly and non-elderly patients with large vessel occlusion stroke (LVOS). However, evidence from low/middle-income countries remains scarce. We aimed to assess the impact of age on outcomes and determine whether age modifies the effect of EVT under the resource-limited conditions of a public healthcare system in a developing country.METHODS: Pre-specified subgroup analysis of the RESILIENT trial, a multicenter, randomized, controlled trial in Brazil comparing EVT versus medical treatment alone in anterior circulation LVOS. Patients were categorized as non-elderly (<70 years), elderly (≥70 years), and very elderly (≥80 years). The primary endpoint was functional independence (modified Rankin scale 0-2) at 90 days. Logistic regression was performed to identify independent predictors of outcome and to assess age as an effect modifier.RESULTS: Among 221 randomized patients (47.1% females; median [IQR] National Institutes of Health Stroke Scale, 18 [14-21]), 89 (40.2%) were elderly and 37 (16.7%) very elderly. Increasing age was independently associated with lower odds of functional independence in the entire study population (odds ratio [OR]: 0.97; 95% confidence interval [CI]: 0.95-0.99, p = 0.01). Age significantly modified the treatment effect of EVT. Non-elderly patients derived substantial benefit from EVT (OR: 4.08; 95% CI: 1.71-9.76), whereas the benefit was attenuated in elderly (OR: 0.90; 95% CI: 0.17-5.42; p interaction = 0.03) and very elderly (OR: 0.36; 95% CI: 0.11-3.21; p interaction = 0.03). INTERPRETATION: The effect of EVT appears significantly diminished among elderly patients in a public healthcare system in a developing country. Further studies are needed to understand the mechanism underlying these findings and properly assess the efficacy of EVT in this vulnerable population. ANN NEUROL 2026.

AB - OBJECTIVE: Randomized trials from high-income countries have shown that endovascular treatment (EVT) yields similar benefits in elderly and non-elderly patients with large vessel occlusion stroke (LVOS). However, evidence from low/middle-income countries remains scarce. We aimed to assess the impact of age on outcomes and determine whether age modifies the effect of EVT under the resource-limited conditions of a public healthcare system in a developing country.METHODS: Pre-specified subgroup analysis of the RESILIENT trial, a multicenter, randomized, controlled trial in Brazil comparing EVT versus medical treatment alone in anterior circulation LVOS. Patients were categorized as non-elderly (<70 years), elderly (≥70 years), and very elderly (≥80 years). The primary endpoint was functional independence (modified Rankin scale 0-2) at 90 days. Logistic regression was performed to identify independent predictors of outcome and to assess age as an effect modifier.RESULTS: Among 221 randomized patients (47.1% females; median [IQR] National Institutes of Health Stroke Scale, 18 [14-21]), 89 (40.2%) were elderly and 37 (16.7%) very elderly. Increasing age was independently associated with lower odds of functional independence in the entire study population (odds ratio [OR]: 0.97; 95% confidence interval [CI]: 0.95-0.99, p = 0.01). Age significantly modified the treatment effect of EVT. Non-elderly patients derived substantial benefit from EVT (OR: 4.08; 95% CI: 1.71-9.76), whereas the benefit was attenuated in elderly (OR: 0.90; 95% CI: 0.17-5.42; p interaction = 0.03) and very elderly (OR: 0.36; 95% CI: 0.11-3.21; p interaction = 0.03). INTERPRETATION: The effect of EVT appears significantly diminished among elderly patients in a public healthcare system in a developing country. Further studies are needed to understand the mechanism underlying these findings and properly assess the efficacy of EVT in this vulnerable population. ANN NEUROL 2026.

U2 - 10.1002/ana.78281

DO - 10.1002/ana.78281

M3 - Article

C2 - 42498265

SN - 0364-5134

JO - Annals of Neurology

JF - Annals of Neurology

ER -