Intra-arterial thrombolysis for acute ischemic stroke in octogenarians

It is unclear whether octogenarians benefit from intra-arterial thrombolysis (IAT) for the treatment of acute ischemic stroke (AIS). The aim of the present study was to compare baseline characteristics, clinical outcome and complications of patients aged ≥80 with those of patients aged <80 years.

Forty-three octogenarians and 524 younger patients with AIS were treated with IAT. The modified Rankin scale (mRS) score was used to assess 3-month outcome.

There was a female preponderance among octogenarians (63 vs. 37%, p = 0.015). Stroke severity, occlusion site, and time from stroke onset to IAT did not differ between the groups. Good recanalization (TIMI 2-3) was achieved in 65% of older and in 71% of younger patients (p = 0.449). Rates of symptomatic intracranial hemorrhage (ICH) were 6% in patients <80 years and 2% in octogenarians (p = 0.292). Favorable outcome (mRS 0-2) was less frequent among octogenarians (28 vs. 46%, p = 0.019), while mortality was higher (40 vs. 22%, p = 0.008). Octogenarians died more often from extracerebral complications than younger patients (59 vs. 27%, p = 0.008).

Compared with younger patients, octogenarians did not have a significantly increased risk of symptomatic ICH after IAT. Although favorable outcome was less frequent and mortality rates were higher, IAT appeared to be safe in octogenarians. It seems reasonable to include octogenarians in randomized clinical trials to assess the balance of risk and benefit of IAT in this patient group.