Mechanical Thrombectomy in Nonagenarians

A 95-year-old woman with a medical history of atrial fibrillation and peripheral vascular disease presented acutely to the emergency department because of speech difficulties and hemiparesis on the right side. Her initial National Institute of Health Stroke Scale (NIHSS) score was 17. Diagnostic imaging showed occlusion of the dominant inferior trunk of the left middle cerebral artery. Given her good premorbid clinical condition, mechanical recanalization of the occlusion was performed despite her very advanced age. She improved dramatically and was discharged home with no neurological deficit. One year later, she again presented acutely because of left-sided hemiparesis and anarthria, with an NIHSS score of 18. She was diagnosed with proximal occlusion of the right middle cerebral artery and showed no established infarction. She underwent successful mechanical recanalization. Her neurological condition improved dramatically thereafter, and she was discharged home with an NIHSS score of 2. The potential benefit of mechanical thrombectomy in nonagenarians is the subject of this chapter.