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.
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