Abstract
Introduction Most acute stroke trials exploring the benefits of reperfusion therapies such as intravenous thrombolysis (IVT) and endovascular clot retrieval (ECR) for acute ischaemic stroke have excluded super-elderly patients due to anticipated complications. However, the super-elderly represent the fastest-growing segment of the population, especially in developed nations, and many maintain their functional independence making them eligible for these therapies.
Method In this retrospective study, we explored the clinical outcomes of patients aged 90 years and older who presented to the Canberra Hospital over a period of 6 years, comparing those who received reperfusion therapies with those who were treated conservatively. Outcome was assessed as disability (modified Rankin Score, mRS) and death at 90 days following stroke onset.
Results 70 patients were included, 53 of whom were managed conservatively while 17 had undergone reperfusion therapies. Patients in the intervention group had slightly better premorbid mRS and higher NIHSS scores but there was no significant difference between control and intervention groups at 90-days assessed as mRS 3 and below (30.2% vs 35.3%, p=0.69) or mortality rates (39.6% vs 52.9%, p=0.33). Patients who received intravenous thrombolysis (with or without ECR) had poor clinical outcomes and very high mortality rates, unlike patients treated with ECR alone.
Conclusion The benefit of intravenous thrombolytic therapy for acute ischaemic stroke should be reconsidered in the super-elderly age group. These data suggest that IVT should not be offered to patients over 90 years old, though it is reasonable to continue to offer ECR alone in carefully-selected patients.
