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. 2023 Dec;30(12):3751-3760.
doi: 10.1111/ene.16035. Epub 2023 Aug 24.

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

Ettore Nicolini  1 , Valentina Saia  2 , Svetlana Lorenzano  1 , Giovanni Pracucci  3 , Marta Iacobucci  1 , Manuela De Michele  1 , Stefano Vallone  4 , Mauro Bergui  5 , Marina Diomedi  6 , Patrizia Nencini  7 , Rossana Tassi  8 , Andrea Saletti  9 , Edoardo Puglielli  10 , Andrea Naldi  11 , Sergio Lucio Vinci  12 , Nicola Giannini  13 , Laura Malfatto  14 , Menozzi Roberto  15 , Daniele G Romano  16 , Manuel Cappellari  17 , Andrea Zini  18 , Fabrizio Sallustio  19 , Ilaria Casetta  20 , Enrico Fainardi  3 , Salvatore Mangiafico  21 , Danilo Toni  1 ; IRETAS Group
Collaborators, Affiliations

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

Ettore Nicolini et al. Eur J Neurol. 2023 Dec.

Abstract

Background and purpose: The 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 of whether outcome determinants specific for the latter might vary. Very few data are available on predictors of outcome in young AIS patients receiving endovascular treatment (EVT).

Methods: We analyzed data for patients aged between 16 and 55 years from the Italian Registry of Endovascular Treatment in Acute Stroke. We divided our population into patients <45 years old and patients aged between 45 and 55 years. 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 symptomatic intracerebral hemorrhage in the two groups.

Results: A total of 438 patients younger than 45 years and 817 aged 45-55 years were included; 284 (34.8%) patients aged 45-55 years and 112 (25.6%) patients younger than 45 years old showed poor 90-day functional outcome (p = 0.001). Predictors of poor outcome in the older group were baseline National Institutes of Health Stroke Scale (NIHSS; p < 0.001), diabetes (p = 0.027), poor collateral status (p = 0.036), and groin puncture-to-recanalization time (p = 0.010), whereas Thrombolysis in Cerebral Infarction (TICI) 2b-3 had an inverse association (p < 0.001). Predictors of poor outcome in patients younger than 45 years were baseline NIHSS (p < 0.001) and groin puncture-to-recanalization time (p = 0.015), whereas an inverse association was found for baseline Alberta Stroke Program Early CT Score (p = 0.010) and TICI 2b-3 (p < 0.001).

Conclusions: Approximately one third of young adults treated with EVT do not reach a good functional outcome. Fast and successful recanalization, rather than common risk factors, has a major role in determining clinical outcome.

Keywords: acute ischemic stroke; mechanical thrombectomy; stroke in young adults.

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References

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