Abstract
BackgroundAge increases the risk of mortality and poor prognosis following stroke. The benefit of intravenous thrombolysis in very old patients remains uncertain. The purpose of the study was to evaluate the efficacy and safety of thrombolysis in very old patients considering their perfusion-imaging profile.MethodsWe conducted a retrospective study including patients older than 90 y.o. admitted for an acute ischemic stroke. A computed tomography perfusion-imaging (CTP) was performed in patients who received thrombolysis. Primary outcome was the functional status at 3 months, assessed by the modified Rankin scale (mRS). Secondary outcomes were the rate of hemorrhagic transformations, duration of hospitalization and the rate of death in the first 7 days. Patients receiving thrombolysis were compared with an age-matched group of non-thrombolysed patients.Results78 patients were included (31 % male, aged 92 ± 1.7 y.o). 37 patients received thrombolysis and among them, 30 had CTP with a mismatch. The three months mRS was not significantly different in the two groups (mRS 0–2: 5 % and 7 % in the thrombolysed and non-thrombolysed group, respectively). Hemorrhagic transformations were more frequent in the thrombolysed group (54 % versus 12 %, p = 0.002) and symptomatic intracranial hemorrhage tended to be associated with mRS at three months and death in the first 7 days. Duration of hospitalization was longer in the thrombolysed group (10 days ± 12 versus 7 days ± 9, p = 0.046).ConclusionsPatients who received thrombolysis did not have a better functional prognosis than non-thrombolysed patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0331-1) contains supplementary material, which is available to authorized users.
Highlights
Age increases the risk of mortality and poor prognosis following stroke
While no significant increase of hemorrhagic transformation was observed in these older patients, this worse functional outcome seemed to be related to a worse pre-stroke functional status, a higher clinical severity at baseline, and more frequent post-stroke complications during the acute
Demographic data are described in Table 1. 37 patients received Intravenous thrombolysis (IV-tPA)
Summary
Age increases the risk of mortality and poor prognosis following stroke. The benefit of intravenous thrombolysis in very old patients remains uncertain. The benefit of intravenous thrombolysis (IV-tPA) in ischemic stroke (IS) patients has been widely demonstrated [6, 7] but most of the studies excluded patients older than 80, potentially limiting thrombolysis in this population. That is even more true in the subgroup of very old patients, those aged over 90 y.o., for whom available data are scarce In this population, few studies [4, 10] failed to identify a benefit of IV-tPA on functional outcome or mortality at three months. Few studies [4, 10] failed to identify a benefit of IV-tPA on functional outcome or mortality at three months None of these studies have evaluated the potential benefit of IV-tPA depending on the neuroradiological imaging pattern at baseline. The aim of our study was to evaluate the influence of IV-tPA on the three months functional outcome in a population of patients aged over 90 y.o., considering their perfusionimaging profile
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