Mechanical thrombectomy in young patients with large vessel occlusion‐related ischemic stroke: Data from the Italian Registry of Endovascular Treatment in Acute Stroke

Abstract

BackgroundThe weight of outcome predictors in acute ischemic stroke (AIS) patients older than 60 years is not necessarily mirrored in the younger population, posing the question that outcome determinants specific for the latter might vary. Very few data are available on predictors of outcome of young AIS patients receiving endovascular treatment (EVT).MethodsWe analyzed data of patients aged between 16 and 55 y.o., from the IRETAS registry. We divided our population in patients under 45 y.o. and patients aged between 45 and 55 y.o.. After testing the differences between groups in terms of 90‐day modified Rankin Scale (mRS) 0‐2, mortality and symptomatic intracranial hemorrhage, we looked for predictors of poor outcome (mRS 3‐6), death and sICH in the two groups.Results438 patients under 45 y.o. and 817 aged 45‐55 y.o. were included. 284 (34.8%) patients aged 45‐55 and 112 (25.6%) patients under 45 y.o. showed poor 90‐day functional outcome (p=0.001). Predictors of poor outcome in the older group were baseline NIHSS (p<0.001), diabetes (p=0.027), poor collateral status (p=0.036), and groin‐to‐recanalization time (p=0.010), while TICI 2b‐3 had an inverse association (p<0.001). Predictors of poor outcome in patients under 45 y.o. were baseline NIHSS (p<0.001) and groin‐to‐recanalization time (p=0.015), while an inverse association was found for baseline ASPECTS (p=0.010) and TICI 2b‐3 (p<0.001).ConclusionAbout one third of young adults treated with EVT does not reach a good functional outcome. Fast and successful recanalization, rather than common risk factors have a major role in determining poor clinical outcome.