Abstract DP064: Acute Stroke Intervention in the Elderly

Purpose: A third of all ischemic strokes occur in patients ≥80 years old. However, most clinical trials exclude patients above 80 years old, thus limiting available evidence to guide management for this patient population. Our aim was to compare clinical outcomes of patients 80 years and older presenting with acute ischemic stroke who were eligible candidates for pharmacological therapy and/or thrombectomy to those of the patient population studied in large double-blind randomized controlled trials. Methods: This was a retrospective cohort study of patients ≥80 years old who presented with acute ischemic stroke and were eligible for thrombolysis and/or thrombectomy from January 2023 to March 2025. Patients were stratified by intervention(s) received, clinical justification for deferral of intervention when relevant, and modified Rankin score (mRS) at time of discharge and 90-days. Results: 74 patients met criteria for analysis. Mean age was 87.59 years old and mean pre-morbid mRS was 1.82. 54 of these patients received at least one form of intervention. Median 90-day mRS was calculated for the following groups: no intervention (=4), tenecteplase only (=3), thrombectomy only (=6), and combination tenecteplase and thrombectomy (=4). There is no evidence of a difference in outcome between patients who received intervention and those who did not (p=0.323). There was also no significant difference between outcomes when comparing specific intervention groups (p=0.122). When controlling for presenting NIHSS, the adjusted odds ratio of a poor outcome with intervention was 1.03 (p=0.958, CI 0.39-2.68). Conclusions: Reported 90-day outcomes of intervention are comparable to those who did not receive treatment. Moreover, given increased medical co-morbidities and baseline disability in this age group, the definition of good neurological outcome should incorporate the complex characteristics of this unique population. Our data reinforces the need to develop a more nuanced and data-driven approach to the management of acute ischemic strokes in the elderly population.