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Original research
Endovascular therapy versus thrombolysis in patients with large vessel occlusions within the anterior circulation aged ≥80 years
  1. Andreas Kastrup1,
  2. Freimuth Brunner1,
  3. Helmut Hildebrandt1,
  4. Christian Roth2,
  5. Michael Winterhalter3,
  6. Panagiotis Papanagiotou2
  1. 1 Department of Neurology, Klinikum Bremen-Mitte gGmbH, Bremen, Germany
  2. 2 Department of Neuroradiology, Klinikum Bremen-Mitte gGmbH, Bremen, Germany
  3. 3 Department of Anesthesiology, Klinikum Bremen-Mitte gGmbH, Bremen, Germany
  1. Correspondence to Professor Andreas Kastrup, Department of Neurology, Klinikum Bremen-Mitte, Bremen 28205, Germany; akastrup06{at}


Background and purpose In patients with large vessel occlusions, endovascular treatment (ET) has been shown to be superior to intravenous thrombolysis (IVT) in recent trials. However, the effectiveness of ET in elderly patients is uncertain.

Methods Using our stroke database, we compared the rates of good outcome (modified Rankin scale (mRS) ≤2), excellent outcome (mRS 0–1), poor outcome (mRS 5–6) at discharge, in-hospital death, infarct size, and symptomatic intracranial hemorrhage (SICH) in patients aged ≥80 years with distal intracranial carotid artery, M1 and M2 occlusions during two time periods.

Results From January 2008 to October 2012, 217 patients were treated with IVT and, from November 2012 to October 2017, 209 patients received ET with stent retrievers (with or without IVT). Significantly more patients in the ET group than in the IVT group had a good outcome (25% vs 16%, P<0.05), as well as an excellent outcome (12% vs 4%, P<0.01). Significantly fewer patients in the ET group than in the IVT group died (14% vs 22%, P<0.05) or had a poor outcome (35% vs 52%, P<001). The SICH rates were lower after ET than after IVT (1% vs 6%, P<0.01), and the infarct sizes were smaller after ET than after IVT.

Conclusions Compared with IVT, the routine use of ET significantly improved the early clinical and radiological outcome in patients with anterior circulation large vessel occlusions aged ≥80 years. Nevertheless, poor outcome rates were high so the role of ET needs to be defined further in this population.

  • stroke
  • thrombolysis
  • thrombectomy

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  • Contributors AK, FB, PP: study design, data acquisition, critical data review, interpretation of data. HH, CR, MW: data acquisition and interpretation of data. AK, FB: primary manuscript writing, tables, and figure. AK, FB, HH, CR, MW, PP: critical revision and final approval of the manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Local Ethics Committee of the Ärztekammer Bremen.

  • Provenance and peer review Not commissioned; externally peer reviewed.