[Acute stroke treatment in old age]

Area of Science:

• Neurology
• Geriatrics
• Emergency Medicine

Background:

• Ischemic stroke treatment guidelines often focus on younger populations.
• Elderly patients (over 80) present unique challenges for acute stroke management.
• Evidence-based acute treatments for ischemic stroke include stroke unit care, antiplatelet therapy, IVT, and MT.

Purpose of the Study:

• To evaluate the efficacy and risks of acute ischemic stroke treatments in patients over 80.
• To discuss the indications for invasive treatments like IVT and MT in elderly patients.
• To outline management strategies, including palliative care, for older stroke patients.

Main Methods:

• Review of evidence-based acute treatments for ischemic stroke.
• Analysis of treatment effectiveness and morbidity in patients over 80.
• Consideration of patient comorbidities and age-related factors in treatment decisions.

Main Results:

• Four of five evidence-based acute treatments are effective in patients over 80 but associated with higher morbidity.
• Indications for IVT and MT in the elderly must be individualized based on comorbidities.
• Decompressive craniotomy is generally limited to younger patients (up to 60/70 years).
• Patients over 80 often do not receive IVT or MT, despite general recommendations for IVT use.

Conclusions:

• Acute ischemic stroke treatments can be effective in octogenarians, necessitating careful risk-benefit assessment.
• Individualized treatment plans, considering comorbidities, are crucial for invasive therapies like IVT and MT.
• A timely transition to palliative care is appropriate following treatment failure or in cases of high comorbidity burden.