Treatment of an Acute Left Middle Cerebral Artery (M1) Occlusion in an 89-Year-Old Woman with Mechanical and Aspiration Thrombectomy, with Excellent Clinical Outcome: The Topic of Endovascular Ischemic Stroke Management in Octogenarians

An 89-year-old female patient was alone from 11 a.m. until 3 p.m., when she was found unable to move her right-hand side and to speak. Her medical history indicated that she had arterial hypertension, hyperlipidemia, hypothyroidism, and peripheral arterial disease. Upon admission, her clinical status was rated National Institutes of Stroke Scale (NIHSS) 19. She was hemiparetic on her left-hand side, aphasic, and had hemianopia to the right side of the vertical midline. CT, CTA, and CTP were performed 2 h after the patient was found. Noncontrast CT was unremarkable, with baseline Alberta Stroke Programme Early CT Score (ASPECTS) 10. CTA revealed occlusion of the left M1 segment, and CTP showed a delay of the time to drain without reduced cerebral blood flow and volume. DSA confirmed the embolic left M1 occlusion with extensive leptomeningeal collaterals from the left ACA to the left MCA supply territory. Under general anesthesia, mechanical thrombectomy (pRESET, phenox) and aspiration (SOFIA aspiration catheter, MicroVention) were performed, achieving complete recanalization of the left supply territory in a single pass about 3 hours after the patient was found. She made a rapid and complete recovery within 3 weeks. She had returned to her baseline 3 months later, but then experienced transient dysarthria. MRI revealed a lacunar cerebellar infarct. ECG examinations after her first and second stroke detected a continous sinus rhythm. Arterio-arterial emboli were considered the most likely cause of stroke. The patient passed away of natural causes 1 year after her first ischemic stroke. This case observation is in line with previous reports showing that advanced age per se does not justify withholding thrombectomy from patients with acute large intracranial vessel occlusion.