[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 effectiveness and risks of acute ischemic stroke treatments in patients over 80.
• To guide the application of invasive treatments like IVT and MT in elderly individuals.
• To define appropriate therapeutic strategies, including palliative care, for older stroke patients.

Main Methods:

• Review of evidence-based acute treatments for ischemic stroke.
• Analysis of treatment efficacy and morbidity in patients over 80.
• Consideration of patient comorbidities in treatment indication.
• Evaluation of decompressive craniotomy age limits.
• Assessment of IVT and MT utilization in the elderly.

Main Results:

• Four of five acute ischemic stroke 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 patients under 60/70 years.
• Patients over 80 often do not receive IVT or MT.
• Alteplase for IVT in patients over 80 is generally recommended despite careful indication review.

Conclusions:

• Acute ischemic stroke treatments can be effective in patients over 80, necessitating individualized care plans.
• Careful consideration of comorbidities and potential risks is crucial for invasive treatments like IVT and MT in the elderly.
• A transition to palliative care is appropriate following the failure of acute interventions.