Real-World Outcomes of Ischemic Stroke Interventions in Older Patients: A Cohort Study from a Tertiary Medical Center

Background: Evidence regarding optimal reperfusion strategies in older patients with acute ischemic stroke remains inconsistent, particularly in real-world settings where patient selection and comorbidity burden differ from randomized trials. Objective: This study evaluates real-world outcomes of ischemic stroke interventions among older adults in a tertiary medical center. Methods: This single-center retrospective cohort study included patients aged ≥ 65 years with acute ischemic stroke admitted between August 2022 and December 2023. Mortality follow-up continued until September 2024. Patients were categorized according to treatment: intravenous thrombolysis (tPA) alone, endovascular thrombectomy (EVT) alone, or combined (tPA + EVT) therapy. Data included demographics, comorbidities, stroke severity (NIHSS), imaging, treatment timing, and mortality outcomes. Results: Among 200 patients (mean age 77.5 years), 66 received tPA, 86 underwent EVT, and 48 received tPA + EVT therapy. Patients treated with tPA alone presented with milder strokes and had low in-hospital and six-month mortality (1.5% and 6.1%, respectively). In contrast, EVT-only patients had substantially higher in-hospital and six-month mortality (21% and 43%, respectively). Patients receiving tPA + EVT therapy had low mortality rates comparable to the tPA group (2.1% and 6.3%, respectively), despite greater stroke severity at presentation. Conclusions: Despite greater stroke severity, patients receiving tPA + EVT therapy had outcomes comparable to those treated with tPA alone, while EVT-only patients experienced substantially higher mortality. These findings underscore the importance of patient selection and suggest that treatment allocation may strongly influence real-world outcomes in older adults.