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Open Access 24-02-2022 | Stroke | Original Article

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

Authors: Giovanna Viticchi, Eleonora Potente, Lorenzo Falsetti, Marco Burattini, Marco Bartolini, Laura Buratti, Giuseppe Pelliccioni, Mauro Silvestrini

Published in: Neurological Sciences | Issue 7/2022

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.

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Title: Efficacy and safety of reperfusion treatments in middle-old and oldest-old stroke patients
Authors: Giovanna Viticchi
Eleonora Potente
Lorenzo Falsetti
Marco Burattini
Marco Bartolini
Laura Buratti
Giuseppe Pelliccioni
Mauro Silvestrini
Publication date: 24-02-2022
Publisher: Springer International Publishing
Keywords: Stroke
Thrombectomy
Published in: Neurological Sciences / Issue 7/2022
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-022-05958-4

At a glance: The STEP trials

Springer Medicine

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

Abstract

Introduction

Patients and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Patients and methods

Results

Conclusions

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