[Management of Acute Ischemic Stroke in Older Adults: What's New in Thrombolysis and Thrombectomy up to 24 Hours?].

Authors

Jean-Baptiste Brunet de Courssou, Pierre Clerin, Sandrine Deltour

Published in

Geriatrie et psychologie neuropsychiatrie du vieillissement. Volume 24. Issue 3. Pages 0. Aug 17, 2026. Epub Aug 17, 2026.

Abstract

Population aging is increasing the absolute number of ischemic strokes. At the same time, indications for intravenous thrombolysis and mechanical thrombectomy are expanding through patient selection based on perfusion imaging or MRI findings. Landmark trials have shown that the benefits of intravenous alteplase are maintained in very elderly patients when treatment is initiated early. Tenecteplase is also emerging as an alternative thrombolytic agent, including for older patients. In patients with proximal large-vessel occlusions, mechanical thrombectomy improves functional outcomes across all age groups, and recent trials in patients with large ischemic cores suggest a benefit in carefully selected individuals. Chronological age alone should therefore not be used as an exclusion criterion for reperfusion therapies. Decisions regarding reperfusion in older patients should integrate pre-stroke functional status (modified Rankin Scale [mRS]), frailty, comorbidities, stroke severity, imaging findings, and the patient's goals of care.

PMID:
42606010
Bibliographic data and abstract were imported from PubMed on 17 Aug 2026.

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