Successful Bridging Therapy in a 103-Year-Old Woman with Acute Terminal Internal Carotid Artery Occlusion

Abstract

The efficacy of intravenous thrombolysis and endovascular therapy and their favorable treatment outcomes have been established in clinical trials irrespective of age. Current guidelines do not recommend an age limit in selecting eligible patients for reperfusion treatment as long as other criteria are satisfied. A 103-year-old woman was admitted at our hospital within 1 h of stroke onset secondary to a left internal carotid artery terminus occlusion. On admission, her National Institutes of Health Stroke Scale (NIHSS) score was 30, with a small left thalamic diffusion restriction lesion on MRI. Her medical history included paroxysmal atrial fibrillation, prior myocardial infarction, hypertension, chronic kidney disease, and diabetes mellitus. Her pre-stroke modified Rankin Scale score was 0, and she was fully independent before stroke. Once intravenous thrombolysis was started, the patient successfully underwent mechanical thrombectomy, and thrombolysis in cerebral infarction-3 recanalization was achieved 225 min after symptom onset. She showed dramatic recovery (NIHSS score of 5 after 48 h) and was discharged on day 7 with a modified Rankin Score of 1. To our knowledge, our patient is the second oldest documented patient who successfully underwent bridging therapy for stroke.