Centenarian middle cerebral artery occlusion treated with intra-arterial mechanical embolectomy: Figure 1

Abstract

Advanced age, arbitrarily defined as over 80 years, has been an exclusion criterion in many clinical trials for the treatment of acute ischemic stroke. The oldest person, to our knowledge, treated for acute ischemic stroke with intra-arterial therapy is presented and, importantly, this patient was excluded from intravenous tissue plasminogen activator due to an advanced age of 100 years and arrival in our emergency department within the 3-4.5 h time window. Utilizing an MRI based protocol to assess the risk-benefit ratio, treatment by intra-arterial mechanical embolectomy was commenced resulting in middle cerebral artery recanalization at 6 h 30 min. The patient improved, and ultimately returned to a baseline modified Rankin Scale score of 3. With careful selection, elderly patients may benefit from acute stroke therapies and may be considered on a case by case basis.

Successful Mechanical Thrombectomy for Acute Middle Cerebral Artery Occlusion in a Centenarian

“…However, poor outcomes with MT have also been reported in patients >90 years of age [16]. Besides our case, there have been four reports of MT in centenarians (Table 1) [8][9][10][11]. Five of the six patients suffered a cardioembolic stroke, whereas one had an atherothrombotic brain infarction; however, arterial tortuosity rendered the management of two of the six patients difficult.…”

“…A study reported that mechanical thrombectomy (MT) does not lead to good outcomes in patients over 80 years of age [6], whereas another stated that MT can improve outcomes in patients over 90 years of age [7]. There are even fewer reports in the literature on centenarians [8][9][10][11]. Herein, we describe the case of a 100-year-old woman who underwent MT and had a good outcome.…”