Minimally Invasive Endovascular Treatment With Integrated Perioperative Management in a 97-Year-Old Patient With...

Treatment decisions for subarachnoid hemorrhage (SAH) in nonagenarians are challenging due to the need to balance poor prognosis against treatment invasiveness. A 97-year-old woman with a premorbid modified Rankin Scale (mRS) score of 3 presented with acute-onset headache, dizziness, and vomiting. Computed tomography revealed SAH with intraventricular hemorrhage. Further imaging demonstrated a ruptured dissecting aneurysm of the left posterior inferior cerebellar artery (PICA) (World Federation of Neurosurgical Societies Grade 2, Hunt and Kosnik Grade 3, modified Fisher Group 4). Although conservative management was initially considered, endovascular coil embolization via distal transradial access (dTRA) was performed based on the family's preference for active treatment. Targeted embolization of the dissecting "pearl" was achieved while preserving PICA flow. The procedure was completed without complications, achieving near-complete occlusion with a neck remnant. No symptomatic vasospasm or delayed cerebral ischemia (DCI) occurred. The patient was transferred back to the referring hospital with a functional status comparable to baseline (mRS score of 3). This case demonstrates that favorable early outcomes may be achieved in selected nonagenarian patients through appropriate patient selection and minimally invasive strategies. It highlights the potential value of an integrated approach combining low-profile endovascular techniques with meticulous, individualized perioperative management in the context of a super-aging society.