Outcomes of young patients following mechanical thrombectomy for stroke: A systematic review and meta-analysis

Abstract

Background Young patients experience acute ischemic stroke (AIS) at much lower rates than their older counterparts. We performed a systematic review and meta-analysis to assess the question regarding outcomes and clinical characteristics of young stroke patients who underwent mechanical thrombectomy for AIS. Methods Following PRISMA guidelines, a systematic review of the literature was conducted using the databases PubMed, MEDLINE, and Embase. The primary outcome of interest was 90-day modified Rankin Scale (mRS) 0–2. Secondary outcome variables included rate of successful reperfusion (TICI 2b/3), symptomatic intracerebral hemorrhage (sICH), and mortality. Using R software version 4.1.2, we calculated pooled event rates and their corresponding 95% confidence intervals (CI) for all outcomes. Results Our analysis included eight studies with a total of 1903 patients. Definitions of young patients included age ranges of 18–49/50 years, 18–54/55 years, and 18–64/65 years. Functional independence was achieved in 62.0% of the patients, with an overall mortality of 9.0%. Moreover, successful reperfusion was achieved in 82.0% of the patients with sICH rates of 5.7%. There was significant heterogeneity among different analyses, which could not be attributed to the differences of the definition of young patients. Conclusions Following mechanical thrombectomy for AIS, patients aged 18–65 years achieved relatively high rates of functional independence and successful reperfusion and low rates of mortality and sICH. Clinical Perspective In this systematic review and meta-analysis of eight studies, we examined outcomes in young stroke patients, aged 18–65 years old, following mechanical thrombectomy for acute ischemic stroke. We found that young patients achieved high rates of functional independence, high rates of successful reperfusion, and low rates of mortality and symptomatic intracerebral hemorrhage. While there have been several papers examining outcomes following mechanical thrombectomy for acute ischemic stroke in young patients, the results of these studies have yet to be pooled together in a meta-analysis. Our results indicate that young patients have good outcomes following mechanical thrombectomy. Further studies that examine these outcomes are warranted so that a higher-powered analysis can be performed to better informed clinicians regarding outcomes in this patient age-group cohort.

Outcomes of Patients With Atrial Fibrillation Following Thrombectomy for Stroke

“…Patients with AF also tend to be older, and it has been previously shown that younger patients have better outcomes following MT for AIS . All studies in our systematic review and meta-analysis reported that patients with AF were older than their counterparts without AF, which is consistent with patients with AF in general.…”

To Use Perfusion Imaging or Not in Patient Selection for Late Window Endovascular Thrombectomy?

“…After analyzing data from 5 multicenter observational studies including a total of 3,384 patients treated with EVT within 6-24 hours from symptom onset, they found comparable rates of 3-month functional independence and symptomatic intracranial hemorrhage between those selected by noncontrast CT and those selected by CTP. 7 However, patients selected by CTP were found to have a 31% higher likelihood of postprocedural successful reperfusion and a 21% lower odds for mortality at 3 months. 7 The findings in this meta-analysis by Kobeissi et al derive from observational studies, which are prone to confounding.…”

“…7 However, patients selected by CTP were found to have a 31% higher likelihood of postprocedural successful reperfusion and a 21% lower odds for mortality at 3 months. 7 The findings in this meta-analysis by Kobeissi et al derive from observational studies, which are prone to confounding. The lower mortality of patients selected by CTP compared with those selected by noncontrast CT could be related to selection bias in favor of the group selected by CTP, a notion that, however, is not further supported by the lack of difference in functional outcomes between the 2 groups.…”

“…Patient selection in the late window based solely on the assessment of early ischemic changes on noncontrast CT has been suggested as a more pragmatic and inclusive alternative. Kobeissi et al 7 performed a systematic review and meta-analysis comparing the outcomes of patients presenting within 6-24 hours from stroke onset and treated with EVT after being selected by either noncontrast CT or CTP. After analyzing data from 5 multicenter observational studies including a total of 3,384 patients treated with EVT within 6-24 hours from symptom onset, they found comparable rates of 3-month functional independence and symptomatic intracranial hemorrhage between those selected by noncontrast CT and those selected by CTP.…”

“…Because randomized studies formally addressing the question of whether noncontrast CT could be noninferior to CTP for selecting patients for EVT in the late therapeutic window are currently unavailable, evidence from observational studies summarized in meta-analyses can be highly informative after acknowledging the limitations, as mentioned in the study conducted by Kobeissi et al 7 and further discussed earlier. The comparative utility of noncontrast CT to CTP for selecting candidates for EVT in the late time window has been a widely debated topic in acute stroke care, but it is now expected to cool down after the recent publication of SELECT2 (A Randomized Controlled Trial to Optimize Patient's Selection for Endovascular Treatment in Acute Ischemic Stroke) 8 and ANGEL-ASPECT (Endovascular Therapy in Acute Anterior Circulation Large Vessel Occlusive Patients with a Large Infarct Core).…”