Efficacy and safety of reperfusion treatments in middle-old and oldest-old stroke patients

Abstract

Introduction Intravenous thrombolysis (IT) and mechanical thrombectomy (MT) have significantly changed the clinical outcome of acute ischaemic stroke (AIS). Concerns about possible complications often reduce the use of these treatment options for older patients, preferentially managed with antiplatelet therapy (AT). Aim of this study was to evaluate, in a population of middle-old (75–84 years) and oldest-old (≥ 85 years) subjects, the efficacy and safety of different treatments for AIS (IT, IT + MT, MT or AT), mortality and incidence of serious complications. Patients and methods All patients aged over 75 years admitted for AIS in two Stroke Units were enrolled. The physician in each case considered all treatment options and chose the best approach. NIHSS and modified Rankin Scale (mRS) were obtained and differences between admission and discharge scores, defined as delta(NIHSS) and delta(mRS), were calculated. The relationship between delta(NIHSS), delta(mRS) and type of procedure was analysed with a GLM/Multivariate model. Differences in mortality and incidence of serious complications were analysed with the chi-square test. Results A total of 273 patients, mean age 84.07 (± 5.47) years, were included. The Delta(NIHSS) was significantly lower in patients treated with AT than in those treated with IT and MT (p < 0.009 and p < 0.005, respectively). Haemorrhagic infarction occurrence was significantly lower (p < 0.0001) among patients treated with AT (10.6%) or IT (16.7%) compared to MT (34.9%) or MT + IT (37.0%). No significant difference was observed for in-hospital mortality. Age did not influence the outcome. Conclusions Our results suggest that IT and AT are effective and relatively safe approaches in middle-aged and older patients.

Clinical Outcomes of Reperfusion Therapies in Elderly Patients with Acute Ischemic Stroke

“…Different studies show that patients over 80 years have an increased risk of unfavorable outcomes and higher mortality rates when compared to their younger counterparts. However, based on the outcome these studies support the safety and feasibility of reperfusion therapies in patients over 80 years of age [Willey JZ et al, 2012;Heja M et al, 2021;Sudre J et al, 2021;Viticchi G et al, 2022].…”

“…The number of patients aged 80 years or over was 41 (18,9%). The median stroke onset time at arrival was 150min., (IqR110-220), the median National Institutes of Health Stroke Scale at admission was [11][12][13][14][15][16][17]. The most common comorbidities were hypertension (75.6%) and atrial fibrillation (39%).…”