Efficacy of intravenous reperfusion treatment in acute ischaemic stroke with age-dependent variables: a 10-year single-centre study

Mechanical thrombectomy is the gold standard in acute ischaemic stroke management; however, intravenous thrombolysis remains essential, particularly in settings without access to endovascular therapy. Given its ongoing relevance, we aimed to investigate the age-related clinical, radiological and procedural factors affecting outcomes after intravenous thrombolysis.

We retrospectively evaluated patients who had acute neurological deficits within the first 4.5 h after the onset of symptoms and were given intravenous tissue plasminogen activator therapy. Patients were divided into three groups according to their age: <55, 55-75 and >75 years. A modified Rankin Scale 0-2 was considered as a good functional outcome.

A total of 432 patients were included in the study, of whom 196 (45.1%) were women. The prevalence of diabetes mellitus (DM) and hypertension increased with age, while smoking was more frequent in patients aged <55 years. Atrial fibrillation was significantly more common in patients aged >75 years. In the >75 years age group, admission National Institutes of Health Stroke Scale (NIHSS) scores were higher ( P = 0.042). The proportion of patients with poor clinical outcomes also increased progressively across the three age groups.

This study underscores age as a key predictor of outcomes following intravenous thrombolysis in acute ischaemic stroke. Among patients aged >75 years, prolonged symptom-to-needle time, atrial fibrillation, higher baseline NIHSS and DM were significantly associated with poor clinical outcomes. Younger patients demonstrated more favourable recovery profiles, whereas advancing age was associated with higher mortality. Notably, DM consistently emerged as a risk factor for unfavourable outcomes across all age groups.