Abstract
IntroductionIntravenous 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 methodsAll 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.ResultsA 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.ConclusionsOur results suggest that IT and AT are effective and relatively safe approaches in middle-aged and older patients.
Highlights
Intravenous thrombolysis (IT) and mechanical thrombectomy (MT) have significantly changed the clinical outcome of acute ischaemic stroke (AIS)
We evaluated the efficacy of different AIS treatments: IT, IT + MT, MT or antiplatelets (AT) in the hyperacute phase and the safety of these therapies by assessing mortality and risk of haemorrhagic infarction (HI)
Delta(NIHSS) resulted significantly lower in antiplatelet therapy (AT), while other treatments were associated to similar scores (Tables 2 and 3)
Summary
Intravenous thrombolysis (IT) and mechanical thrombectomy (MT) have significantly changed the clinical outcome of acute ischaemic stroke (AIS). 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. Intravenous thrombolysis (IT) and mechanical thrombectomy (MT) are the most effective treatments for acute ischaemic stroke (AIS). The vast majority of trials exploring the efficacy and safety of reperfusion therapies have not included subjects ≥ 80 years of age, with the notable exception of the third international stroke trial (IST3) [6], reducing information for proper therapeutic management of older patients. Improvements in therapeutic approaches and early diagnosis, innovation in resuscitation techniques, and increasing attention to healthy lifestyles have increased the average life span in all industrialised countries
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