In patients over 80 years old, 4 of the 5 evidence-based acute treatments of ischemic stroke, i.e. stroke unit treatment, antiplatelet therapy, intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) are effective but with a higher morbidity than in younger patients. The indications for the more invasive forms of treatment, such as IVT and MT are given in principle but have to be oriented to the individual patient comorbidities. In the case of failure of these procedures a consistent therapeutic target change to palliative measures is appropriate. Decompressive craniotomy in space-occupying media infarction can be indicated up to the relative age limit of 60 years and absolute age limit of 70 years. Patients over 80 years often do not undergo IVT or MT. Although the German approval for alteplase within the framework of IVT over the age of 80 years suggests a careful and critical review of the indications, its use is generally recommended.
Keywords: Cerebral ischemia; Decompression, surgical; Intracerebral hemorrhage; Platelet aggregation inhibitors; Thrombolytic therapy.