Outcomes in young adults with acute ischemic stroke undergoing endovascular thrombectomy: A real-world multicenter experience.
acute ischemic stroke
endovascular thrombectomy
functional outcomes
large vessel occlusion
young stroke patients
Journal
European journal of neurology
ISSN: 1468-1331
Titre abrégé: Eur J Neurol
Pays: England
ID NLM: 9506311
Informations de publication
Date de publication:
08 2021
08 2021
Historique:
revised:
22
04
2021
received:
19
03
2021
accepted:
24
04
2021
pubmed:
8
5
2021
medline:
14
8
2021
entrez:
7
5
2021
Statut:
ppublish
Résumé
Endovascular thrombectomy (EVT) is the standard of care for anterior circulation acute ischemic stroke (AIS) with large vessel occlusion (LVO). Young patients with AIS-LVO have distinctly different underlying stroke mechanisms and etiologies. Much is unknown about the safety and efficacy of EVT in this population of young AIS-LVO patients. All consecutive AIS-LVO patients aged 50 years and below were included in this multicenter cohort study. The primary outcome measured was functional recovery at 90 days, with modified Rankin Scale of 0-2 deemed as good functional outcome. A total of 275 AIS-LVO patients that underwent EVT from 10 tertiary centers in Germany, Sweden, Singapore, and Taiwan were included. Successful reperfusion was achieved in 85.1% (234/275). Good functional outcomes were achieved in 66.0% (182/275). Arterial dissection was the most prevalent stroke etiology (42/195, 21.5%). National Institutes of Health Stroke Scale (NIHSS) score at presentation was inversely related to good functional outcomes (aOR: 0.92, 95% CI: 0.88-0.96 per point increase, p < 0.001). Successful reperfusion (aOR: 3.22, 95% CI: 1.44-7.21, p = 0.005), higher ASPECTS (aOR: 1.21, 95% CI: 1.01-1.44, p = 0.036), and bridging intravenous thrombolysis (aOR: 2.37, 95% CI: 1.29-4.34, p = 0.005) independently predicted good functional outcomes. Successful reperfusion was inversely associated with in-hospital mortality (aOR: 0.14, 95% CI: 0.03-0.57, p = 0.006). History of hypertension strongly predicted in-hospital mortality (aOR: 4.59, 95% CI: 1.10-19.13, p = 0.036). While differences in functional outcomes exist across varying stroke aetiologies, high rates of successful reperfusion and good outcomes are generally achieved in young AIS-LVO patients undergoing EVT.
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2736-2744Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021 European Academy of Neurology.
Références
Boot E, Ekker MS, Putaala J, et al. Ischemic stroke in young adults: a global perspective. J Neurol Neurosurg Psychiatry. 2020;91:411-417.
Ekker MS, Boot EM, Singhal AB, et al. Epidemiology, aetiology, and management of ischaemic stroke in young adults. Lancet Neurol. 2018;17:790-801.
Sweid A, Hammoud B, Ramesh S, et al. Acute ischaemic stroke interventions: large vessel occlusion and beyond. Stroke Vasc Neurol. 2020;5(1):80-85
Rennert R, Wali A, Steinberg JA, et al. Epidemiology, natural history, and clinical presentation of large vessel ischemic stroke. Neurosurgery. 2019;85:S4-S8.
Goyal M, Demchuk A, Menon B, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372(11):1019-1030.
Berkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372(1)11-20.
Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015;372(24):2285-2295.
Campbell BC, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372(11):1009-1018.
Jovin TG, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372(11):1009-1018.
Powers WJ, Derdeyn CP, Biller J, et al. American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46(10):3020-3035.
Leung LY, Melkumova E, Thaler DE. Longitudinal care for young adults with stroke. JAMA Neurol. 2017;74(10):1163.
Mocco J, Tawk RG, Jahromi BS, et al. Endovascular intervention for acute thromboembolic stroke in young patients: an ideal population for aggressive intervention? J Neurosurg. 2009;110(1):30-34.
Chalouhi N, Tjoumakaris S, Starke RM, et al. Endovascular stroke intervention in young patients with large vessel occlusions. Neurosurg Focus. 2014;36(31):E36.
Goyal M, Menon BK, Van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723-1731.
Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in multicentre clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. AHA J. 1993;24:35-41.
Pexman JH, Barber PA, Hill MD, et al. Use of the Alberta Stroke Program Early CT score (ASPECTS) for assessing CT scans in patients with acute stroke. Am J Neuroradiol. 2001;22(8):1534-1542.
Hacke W, Kaste M, Fieschi C, et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Lancet. 1998;352:1245-1251.
Fugate JE, Klunder AM, Kallmes DF. What is meant by “TICI”? Am J Neuroradiol. 2013;34:1792-1797.
Farrell B, Godwin J, Richards S, et al. The United Kingdom Transient Ischaemic Attack (UK-TIA) aspirin trial: final results. J Neurol Neurosurg Psychiatry. 1991;54:1044-1054.
Zaidat OO, Castonguay AC, Gupta R, et al. North American Solitaire Stent Retriever Acute Stroke registry: post-marketing revascularization and clinical outcome results. J Neurointerv Surg. 2014;6:584-588.
Mueller-Kronast NH, Zaidat OO, Froehler MT, et al. Systematic evaluation of patients treated with neurothrombectomy devices for acute ischemic stroke: primary results of the STRATIS registry. Stroke. 2017;48:2760-2768.
Meyer L, Alexandrou M, Flottmann F, et al. Endovascular treatment of very elderly patients aged ≥90 with acute ischemic stroke. J Am Heart Assoc. 2020;9:e014447.
Toni D, Ahmed N, Anzini A, et al. Intravenous thrombolysis in young stroke patients: results from the SITS-ISTR. JAMA Neurol. 2012;78:880-887.
Raoult H, Eugène F, Ferré JC, et al. Prognostic factors for outcomes after mechanical thrombectomy with solitaire stent. J Neuroradiol. 2013;40(44):252-259.
Meyer L, Schonfeld M, Bechstein M, et al. Ischemic lesion water homeostasis after thrombectomy for large vessel occlusion stroke within the anterior circulation: the impact of age. J Cereb Blood Flow Metab. 2021;41(1):45-52.
Marsh EB, Llinas RH, Schneider AL, et al. Predicting hemorrhagic transformation of acute ischemic stroke: prospective validation of the HeRS score. Medicine. 2016;95(2):e2430.
Wollenweber FA, Tiedt S, Alegiani A, et al. Functional outcome following stroke thrombectomy in clinical practice. Stroke. 2019;50:2500-2506.
Mulder MJHL, Jansen IGH, Goldhoorn RB, et al. Time to endovascular treatment and outcome in acute ischemic stroke: MR CLEAN Registry results. Circulation. 2018;138:232-240.
Putaala J, Metso AJ, Metso TM, et al. Analysis of 1008 consecutive patients aged 15 to 49 with first-ever ischemic stroke: the Helsinki young stroke registry. Stroke. 2009;40:1195-1203.
Nogueira RG, Gupta R, Jovin TG, et al. Predictors and clinical relevance of haemorrhagic transformation after endovascular therapy for anterior circulation large vessel occlusion strokes: a multicenter retrospective analysis of 1122 patients. J NeuroIntervent Surg. 2014;7:16-21.
Smith WS, Sung G, Saver J, et al. Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial. Stroke. 2008;39:1205-1212.
Roos YBWEM. Intravenous thrombolysis followed by endovascular thrombectomy versus direct endovascular thrombectomy. International Stroke Conference; 2021.
Yang P, Zhang Y, Zhang L, et al. Endovascular thrombectomy with or without intravenous alteplase in acute stroke. N Engl J Med. 2020;382:1981-1993.
Nogueira RG. Systemic thrombolysis randomization in endovascular stroke therapy (SHRINE) collaboration. International Stroke Conference; 2021.
Zi W, Qiu Z, Li F, et al. Effect of endovascular treatment alone vs intravenous alteplase plus endovascular treatment on functional independence in patients with acute ischemic stroke: the DEVT randomized clinical trial. JAMA. 2021;325:234-243.
Suzuki K, Matsumaru Y, Takeuchi M, et al. Effect of mechanical thrombectomy without vs with intravenous thrombolysis on functional outcome among patients with acute ischemic stroke: The SKIP randomized trial. JAMA. 2021;325:229-231.
Chung J-W, Park SH, Kim N, et al. Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification and vascular territory of ischemic stroke lesions diagnosed by diffusion-weighted imaging. J Am Heart Assoc. 2014;3:e001119.
Nedeltchev K, Der Maur TA, Georgiadis D, et al. Ischaemic stroke in young adults: predictors of outcome and recurrence. J Neurol Neurosurg Psychiatry. 2005;76:191-195.
Thomas GN, Lin JW, Lam WWM, et al. Middle cerebral artery stenosis in type II diabetic Chinese patients associated with conventional risk factors but not with polymorphisms of the renin-angiotensin system genes. Cerebrovasc Dis. 2003;16:217-223.
Bang OY, Kim JW, Lee JH, et al. Association of the metabolic syndrome with intracranial atherosclerotic stroke. Neurology. 2005;65:296-298.
Tan NC, Venketasubramanian N, Saw S, et al. Hyperhomocysteinemia and risk of ischemic stroke among young Asian adults. Stroke. 2002;33:1956-1962.