Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Neurointerv Surg. 2012 Sep;4(5):e23. doi: 10.1136/neurintsurg-2011-010082. Epub 2011 Sep 15.
Advanced age, arbitrarily defined as over 80 years, has been an exclusion criterion in many clinical trials for the treatment of acute ischemic stroke. The oldest person, to our knowledge, treated for acute ischemic stroke with intra-arterial therapy is presented and, importantly, this patient was excluded from intravenous tissue plasminogen activator due to an advanced age of 100 years and arrival in our emergency department within the 3-4.5 h time window. Utilizing an MRI based protocol to assess the risk-benefit ratio, treatment by intra-arterial mechanical embolectomy was commenced resulting in middle cerebral artery recanalization at 6 h 30 min. The patient improved, and ultimately returned to a baseline modified Rankin Scale score of 3. With careful selection, elderly patients may benefit from acute stroke therapies and may be considered on a case by case basis.
高龄（定义为 80 岁以上）一直是许多急性缺血性脑卒中治疗临床试验的排除标准。我们报告了迄今为止接受动脉内治疗的最年长的急性缺血性脑卒中患者，重要的是，由于患者年龄为 100 岁且发病至进入我院急诊的时间在 3-4.5 小时时间窗内，该患者被排除在静脉内组织型纤溶酶原激活剂治疗之外。通过应用 MRI 为基础的评估风险获益比的方案，我们对该患者实施了动脉内机械取栓治疗，结果在 6 小时 30 分钟时实现了大脑中动脉再通。患者病情改善，最终恢复至基线时改良 Rankin 量表评分为 3 分。经过仔细选择，老年患者可能从急性脑卒中治疗中获益，并且可以逐个病例进行考虑。
