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. 2022 Jul;43(7):4323-4333.
doi: 10.1007/s10072-022-05958-4. Epub 2022 Feb 24.

Efficacy and safety of reperfusion treatments in middle-old and oldest-old stroke patients

Giovanna Viticchi  1 , Eleonora Potente  2 , Lorenzo Falsetti  3 , Marco Burattini  4 , Marco Bartolini  4 , Laura Buratti  4 , Giuseppe Pelliccioni  2 , Mauro Silvestrini  4
Affiliations

Efficacy and safety of reperfusion treatments in middle-old and oldest-old stroke patients

Giovanna Viticchi et al. Neurol Sci. 2022 Jul.

Abstract

Introduction: Intravenous thrombolysis (IT) and mechanical thrombectomy (MT) have significantly changed the clinical outcome of acute ischaemic stroke (AIS). Concerns about possible complications often reduce the use of these treatment options for older patients, preferentially managed with antiplatelet therapy (AT). Aim of this study was to evaluate, in a population of middle-old (75-84 years) and oldest-old (≥ 85 years) subjects, the efficacy and safety of different treatments for AIS (IT, IT + MT, MT or AT), mortality and incidence of serious complications.

Patients and methods: All patients aged over 75 years admitted for AIS in two Stroke Units were enrolled. The physician in each case considered all treatment options and chose the best approach. NIHSS and modified Rankin Scale (mRS) were obtained and differences between admission and discharge scores, defined as delta(NIHSS) and delta(mRS), were calculated. The relationship between delta(NIHSS), delta(mRS) and type of procedure was analysed with a GLM/Multivariate model. Differences in mortality and incidence of serious complications were analysed with the chi-square test.

Results: A total of 273 patients, mean age 84.07 (± 5.47) years, were included. The Delta(NIHSS) was significantly lower in patients treated with AT than in those treated with IT and MT (p < 0.009 and p < 0.005, respectively). Haemorrhagic infarction occurrence was significantly lower (p < 0.0001) among patients treated with AT (10.6%) or IT (16.7%) compared to MT (34.9%) or MT + IT (37.0%). No significant difference was observed for in-hospital mortality. Age did not influence the outcome.

Conclusions: Our results suggest that IT and AT are effective and relatively safe approaches in middle-aged and older patients.

Keywords: Middle-old; Oldest-old; Stroke; Thrombectomy; Thrombolysis.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Different distribution of delta(NIHSS)
Fig. 2
Fig. 2
Different distribution of delta(mRS)
See this image and copyright information in PMC

References

    1. Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378:11–21. doi: 10.1056/NEJMoa1706442. - DOI - PubMed
    1. Albers GW, Marks MP, Kemp S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018;378:708–718. doi: 10.1056/NEJMoa1713973. - DOI - PMC - PubMed
    1. Agostoni E, Carolei A, Micieli G, et al. The organisation of the acute ischemic stroke management: key notes of the Italian Neurological Society and of the Italian Stroke Organization. Neurol Sci. 2018;39:415–422. doi: 10.1007/s10072-017-3200-6. - DOI - PubMed
    1. Zeevi N, Kuchel GA, Lee NS, et al. Interventional stroke therapies in the elderly: are we helping? AJNR Am J Neuroradiol. 2012;33:638–642. doi: 10.3174/ajnr.A2845. - DOI - PMC - PubMed
    1. Alawieh A, Chatterjee A, Feng W, et al. Thrombectomy for acute ischemic stroke in the elderly: a ‘real world’ experience. J Neurointerv Surg. 2018;10:1209–1217. doi: 10.1136/neurintsurg-2018-013787. - DOI - PubMed