Outcome of intravenous recombinant tissue plasminogen activator for acute ischemic stroke in patients aged over 80 years

Mione, Gioia; Ducrocq, Xavier; Thilly, Nathalie; Lacour, Jean‐Christophe; Vespignani, Hervé; Richard, Sébastien

doi:10.1111/ggi.12565

Cited by 10 publications

(9 citation statements)

References 23 publications

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“…Some studies have investigated treatment with conventional intravenous thrombolysis in the elderly 17 , 22) , however, patients over 80 years of age were mostly excluded from trials, and no large-scale studies distinctly investigated age-specific outcomes of mechanical thrombectomy 4) . The aging population is more susceptible to decreased neuronal plasticity, considerably due to a lack of neurologic restoration, therefore, older infarction patients have poorer overall outcomes 5) .…”

Section: Introductionmentioning

confidence: 99%

Significances and Outcomes of Mechanical Thrombectomy for Acute Infarction in Very Elderly Patients : A Single Center Experience

Kim

Sung

et al. 2017

J Korean Neurosurg Soc

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ObjectiveMechanical thrombectomy is increasingly being used for the treatment of acute ischemic stroke. The population over 80 years of age is growing, and many of these patients have acute infarction; however, these patients are often excluded from clinical trials, so the aim of this study was to compare the functional outcomes and complication rates in very elderly patients (age ≥80 years) and aged patients (60–79 years) treated with mechanical thrombectomy.MethodsBetween January 2010 and June 2015, we retrospectively reviewed 113 senior patients (over 60 years old) treated at our institution for acute ischemic stroke with mechanical thrombectomy. They were divided into a very elderly (≥80 years) and aged (60–79 years) group, with comparisons in recanalization rates, complications, death and disability on discharge be reported.ResultsThe mean age was 70.3 years in the aged group and 83.4 years in the very elderly group. Elderly patients had higher rates of mechanical thrombectomy failure than the younger group (40% vs. 14%; odds ratio [OR] 4.1; 95% confidence interval [CI] 1.4–11.9; p=0.012). Results from thrombolysis in cerebral ischemia and modified Rankin scale at discharge were worse in the older group (p=0.005 and 0.023 respectively). There were no differences in mortality rate or other complications, but infarction progression rates were significantly higher in the very elderly group. (15% vs. 2.2%; OR 8.0; 95% CI 1.2–51.7; p=0.038). The majority (92.3%) of the patients who failed in aged group were not successful after several trials. However, in half (4 of 8) of the very elderly group, the occlusion site could not be accessed.ConclusionPatients older than 80 years of age undergoing mechanical thrombectomy for acute infarction were more difficult to recanalize due to inaccessible occlusion sites and had a higher rate of infarction progression, However, mortality and other complications were similar to those in younger patients.

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Section: Introductionmentioning

confidence: 99%

Significances and Outcomes of Mechanical Thrombectomy for Acute Infarction in Very Elderly Patients : A Single Center Experience

Kim

Sung

et al. 2017

J Korean Neurosurg Soc

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“…We have read with interest the study by Mione et al, recently published in Geriatrics & Gerontology International. 1 This study heats the debate about the risk-benefit ratio of thrombolysis in older adults. Indeed, despite the fact that the randomized controlled study Third International Stroke Trial (IST-3) 2 and a meta-analysis 3 on Recombinant Tissue Plasminogen Activator (rt-PA) for acute stroke suggest that i.v.…”

Section: Thrombolysis In Older Adults: To Do or Not To Do This Is Thmentioning

confidence: 85%

Thrombolysis in older adults: To do or not to do, this is the question!

Rota

Morelli

Immovilli

et al. 2016

Geriatrics Gerontology Int

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“…The secondary outcomes were sICH (symptomatic intracranial hemorrhage) and mortality at seven days and 90 days. We used the de nitions of sICH in the following three studies: Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST)(8), National Institute of Neurological Disorders and Stroke (NINDS) (9), and European Cooperative Acute Stroke Study (ECASS ) (10).…”

Section: De Nition Of End and Clinical Outcome Measurementmentioning

confidence: 99%

Early Neurological Deterioration in Acute Ischemic Stroke Patients after Intravenous Thrombolysis with Alteplase Predicts Poor 3-Month Functional Prognosis - Data from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China)

Che

Wang

et al. 2022

Preprint

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Background： We aimed to investigate the risk factors of early neurological deterioration (END) after intravenous thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) and the relationship between END and poor 3-month functional outcomes.Methods: Patients who accepted intravenous recombinant rt-PA were enrolled continuously. END was defined as an increase of National Institute of Health Stroke (NIHSS) score ≥ 4 points or death within 24 hours after intravenous thrombolysis. The modified Rankin Scale (mRS) score was recorded to evaluate the functional prognosis of stroke, and the poor 3-month prognosis was defined as an mRS score ≥ of 3. Univariate and multivariate analyses were used to analyze the risk factors of END. The relation between END and 3-month functional outcome was analyzed by multivariate logistic regression analysis. Results: A total of 1107 patients (mean age, 63.42±11.33 years; 673 males) were included in the final analysis, and 81(7.32%) patients had END. In multivariate analysis, the serum glucose level was significantly associated with END; the odds ratio was 1.10 (95% CI 1.03 to 1.18, p =0.004). The multivariate logistic analysis showed END has a notable association with the poor 3-month functional recovery even after adjusting for confounding factors; the adjusted OR was 8.25 (95% CI 3.77 to 18.03, p<0.0001). Conclusions: The initial serum glucose level might be an independent risk factor of END, and END might predict a poor 3-month prognosis.

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Outcome of intravenous recombinant tissue plasminogen activator for acute ischemic stroke in patients aged over 80 years

Abstract: Rt-PA therapy would appear to improve prognosis in the elderly with ischemic stroke. This suggests that age alone should no longer be a barrier to rt-PA therapy. Geriatr Gerontol Int 2016; 16: 843-849.

Cited by 10 publications

References 23 publications

Significances and Outcomes of Mechanical Thrombectomy for Acute Infarction in Very Elderly Patients : A Single Center Experience

Significances and Outcomes of Mechanical Thrombectomy for Acute Infarction in Very Elderly Patients : A Single Center Experience

Thrombolysis in older adults: To do or not to do, this is the question!

Early Neurological Deterioration in Acute Ischemic Stroke Patients after Intravenous Thrombolysis with Alteplase Predicts Poor 3-Month Functional Prognosis - Data from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China)

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