Predictors of favorable outcome after endovascular thrombectomy for acute ischemic stroke due to large vessel occlusion in young patients

Abstract

Background Mechanical thrombectomy (MT) became a standard of care for patients with acute ischemic stroke (AIS) with its efficacy demonstrated by meta-analysis and randomized studies. Although ischemic stroke is associated more with older patients, it may also have devastating neurological effects on young patients. Purpose To present our experience with stroke patients aged <50 years treated with endovascular means and to evaluate clinical and procedural factors associated with outcome and mortality. Material and Methods This study was conducted on 34 young stroke patients treated with MT. Clinical features including baseline results, radiological imaging, procedural details, and outcome results were documented and evaluated. Recanalization was assessed according to the TICI score. The clinical condition was evaluated after three months using mRS. Mortality rate was calculated. Results The rate of successful recanalization (TICI ≥2c) was 79% (27/34). Symptomatic intracranial hemorrhage (sICH) was observed in 5 (15%) patients. After 90 days, the mortality rate was 12%. Favorable clinical outcome (mRs 0–2) was regained in 65% of the patients whereas satisfactory clinical outcome was seen in 85%. Poor clinical outcome (mRs >2) was observed in 9 (23.7%) patients. Conclusion In conclusion, the results of this study demonstrate that MT for AIS in young patients is feasible and provides an excellent rate of arterial recanalization and high rate of favorable outcomes. Statistical analysis showed that shorter time from onset to arrival and reperfusion, successful recanalization and absence of hemorrhagic transformation are the predictors of favorable clinical outcome and overall survival rate.

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

“…Other cardiovascular risk factors, such as atrial fibrillation, hypertension, and dyslipidemia, usually strong predictors of outcome in ischemic stroke patients [17–20], were less prevalent in our study population as compared to the cohort described by Putaala et al [5], which might explain their lack of association with clinical outcome. However, our data are in line with the findings from a large cohort study on young strong patients receiving IV thrombolysis, which did not find any association between classical risk factors and 90‐day mRS, except for age [20].…”

“…Other cardiovascular risk factors, such as atrial fibrillation, hypertension, and dyslipidemia, usually strong predictors of outcome in ischemic stroke patients [17][18][19][20], were less prevalent in our study population as compared to the cohort described by Putaala et al [5],…”

“…We included 1255 patients aged 16-55 years, with a mean (±SD) age of 46 years (±7.88); 552 (44%) were females. Baseline median National Institutes of Health Stroke Scale (NIHSS) was 15 (IQR = [11][12][13][14][15][16][17][18][19]. As for procedural variables, 959 (78%) procedures ended with successful recanalization (TICI 2b-3), with a median onset-to-recanalization time of 240 min (IQR = 175-317).…”

“…Diabetes was more frequent in patients with poor outcome (8.4%) than in the rest of the cohort (3.5%, p = 0.006), as well as arterial hypertension (33.1% vs. 24.3%, p = 0.003). Baseline median NIHSS was higher in the poor outcome group (18 [IQR = [14][15][16][17][18][19][20][21][22] vs.…”

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

“…From the eight studies included in our systematic review, a total of 1903 patients were included. Three studies included patients from the ages of 18-54/55 years, [18][19][20] three studies included patients from 18-49/50 years, [21][22][23] and two studies included patients from 18-64/65 years. 24,25 Mean follow-up duration was 3 months for all trials.…”