Mechanical Thrombectomy for Acute Ischemic Stroke in Nonagenarian Patients: A Case Report from dr. Cipto Mangunkusumo National Hospital, Jakarta, Indonesia

Abstract

Background: Mechanical thrombectomy is the recommended therapy for acute ischemic stroke (AIS) caused by large vessels occlusion within 6-24 hours since onset. However, previous trials about endovascular treatment for AIS only separated the population into <80 years-old and ≥80 years-old groups. Patients greater than 80 years old were found to be associated with poorer clinical outcome and increased mortality. However, in this study we reported a case of revascularization in nonagenarian (>90 years old) with acute ischemic stroke.

Case Presentation: A 93-years-old man with chief complaint of sudden weakness of his left side extremities, slurred speech, and facial palsy since 3.5 hours before admission. In the ER, GCS was E4M6V5 with paresis of 7th and 12th left cranial nerve, and left lateralization of motoric strength. NIHSS score was 12 and code stroke was activated. CT scan showed large vessel occlusion in the right MCA. IV thrombolysis and mechanical thrombectomy was performed using stent retriever. Three clots were successfully removed and TICI 3 was achieved.

Conclusion: Successful reperfusion in elderly and nonagenarian patients was ranging from 56-78% in several studies. Lower NIHSS at baseline, shorter delay between onset and reperfusion, high ASPECT score on initial brain imaging, and first-pass effect are good predictors of mechanical thrombectomy. Several complications including ICH could happen in 28% of cases but only 4-7% patients have symptoms.