Abstract: Objective To investigate the effect edaravone before or after recombinant tissue plasminogen activator (rt-PA) on the outcome of acute ischemic stroke in the elderly patients. Methods A retrospective cohort study was conducted using the stroke register database in the Second Affiliated Hospital of Nanjing Medical University. A total of 135 elderly patients with ischemic stroke from 2014 to 2018 were selected. The patients received edaravone before rt-PA administration were enrolled as study group (n=67), and those who received edaravone after rt-PA were enrolled as control group (n=68). The scores of modified Rankin Scale (mRS) 90 d after treatment, National Institutes of Health Stroke Scale (NIHSS) scores 24 h and 7 days after intravenous thrombolysis, the incidence rate of acute cerebral infarction hemorrhagic transformation, 7-day and 90-day mortality were compared between the two groups. Results The NIHSS scores 24 h and 7 days after intravenous thrombolysis were lower in study group than those in control group (8. 67±8. 55 vs 11. 88±8. 30; 5. 08±5. 35 vs 8. 60±7. 91), 90 d recanalization rate was higher in study group than that in the control group (53. 73% vs. 27. 94%). The rates of intracranial hemorrhage (ICH) (9. 1% vs. 18. 3%) and the rate of symptomatic intracranial hemorrhage (sICH) (2. 0% vs. 8. 7%) in study group were lower than those in control group. Logistic regression analysis showed that the administration of edaravone before rt-PA was significantly associated with lower mRS scores of the patients (OR=0. 28, 95%CI: 0. 14-0. 58). Conclusions The administration of edaravone before rt-PA may improve the outcome in the elderly patients with acute ischemic stroke treated with rt-PA.

Key words: acute ischemic stroke, aged, edaravone, recombinant tissue plasminogen activator, outcome