Mechanical thrombectomy in centenarians for the treatment of acute stroke: Report of 4 patients and review of the literature

Mechanical thrombectomy is widely used for the treatment of acute ischemic stroke secondary to intracranial large vessel occlusion and current guidelines do not impose an upper age limit for the procedure, however, the latest review of the literature on this subject in English reports only 6 centenarians who have undergone cerebral thrombectomy. In this largest series to date, we present 4 additional centenarians (age 100 or older) who underwent endovascular treatment for acute intracranial large vessel occlusion. Three patients were functionally independent prior to stroke, while one had a prestroke modified Rankin scale (mRS) score of 3. Successful recanalization was achieved in all of these elderly patients (TICI scores of 2b in 2 patients and 3 in 2 patients), leading to good clinical outcomes in 3 patients. There were no procedure-related permanent clinical complications. One nontarget distal embolization was successfully managed with anterior cerebral artery thrombectomy without residual deficits. Beyond our cases, we identified additional reports not included in a recent literature review, bringing the total number of documented centenarian cases available for our literature review to 14. Our review suggests a potential selection and publication bias in the reporting of mechanical thrombectomy outcomes in patients aged a hundred years or above. Nevertheless, the available evidence suggests that in carefully selected patients, particularly those with limited acute infarction and a prestroke mRS score of 3 or lower, good clinical outcomes are achievable in centenarians. Therefore, these patients should not be excluded from mechanical thrombectomy based solely on their age.