Abstract Number: Esoc2026a799 Intravenous Rt-Pa Therapy for Acute Ischemic Stroke in Patients Aged ≥90 Years: A Single-Center Retrospective Study

Abstract Background and aims With rapid population aging in Japan, clinicians increasingly encounter very elderly patients with acute ischemic stroke (AIS), and decisions regarding intravenous recombinant tissue plasminogen activator (iv-rt-PA) therapy in patients aged ≥90 years remain challenging. We investigated the use and outcomes of iv-rt-PA therapy in patients aged ≥90 years admitted to our hospital. Methods Among 17,381 patients with AIS admitted between October 2005 and September 2025, patients aged ≥90 years arrived within the therapeutic time window for rt-PA were retrospectively identified. Patients were classified into rt-PA-treated and non-rt-PA-treated groups, and clinical characteristics and outcomes were compared. Results During the study period, 1,498 patients aged ≥90 years were admitted with AIS, of whom 589 patients (39.3%) arrived within the therapeutic time window for rt-PA. Among these patients, 121 (20.5%) received rt-PA and 467 (79.3%) did not. There were no significant differences between rt-PA and non-rt-PA groups in age (92 vs. 92 years, p=0.508) or NIHSS score at admission (13 vs. 15, p=0.905). Mechanical thrombectomy was performed more frequently in the rt-PA group (26.4% vs. 15.6%, p=0.006). Symptomatic intracerebral hemorrhage (SIH) related to rt-PA was observed in 2.5%. Among patients living at home before onset, discharge home or transfer for rehabilitation was more frequent in the rt-PA group (66.3% vs. 49.7%, p=0.007). Conclusions In patients aged ≥90 years with AIS living at home before onset, iv-rt-PA therapy was associated with a higher rate of favorable discharge outcomes without SIH. Iv-rt-PA may be a reasonable treatment option even in patients aged ≥90 years. Conflict of interest Hiromi Ihoriya. nothing to disclose