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ABSTRACT:

Very elderly (age ≥80yo) individuals account for about one-third of all stroke admissions, but the risks and benefits of intravenous thrombolysis (IV-tPA) and endovascular thrombectomy (EVT) in this growing population remain unclear. Thrombolysis is generally used less often for elderly individuals in the United States than younger age groups, likely due to the potential for worse outcomes in comparison. Very elderly individuals were under-represented in early thrombolysis trials, yet contemporary reperfusion trials, as well as meta-analysis, included a greater proportion of very elderly individuals. Pooled analyses from current reperfusion trials suggest that IV-tPA and EVT are safe and effective therapies for very elderly individuals presenting with acute ischemic stroke. Future prospective studies are needed to further assess the safety and effectiveness of acute reperfusion in this growing population. In this review, we examined age-related differences in clinical outcomes for acute ischemic stroke therapies.