Mechanical thrombectomy in young patients with large vessel occlusion-related ischemic stroke: Data from the Italian Registry of Endovascular Treatment in Acute Stroke.
acute ischemic stroke
mechanical thrombectomy
stroke in young adults
Journal
European journal of neurology
ISSN: 1468-1331
Titre abrégé: Eur J Neurol
Pays: England
ID NLM: 9506311
Informations de publication
Date de publication:
12 2023
12 2023
Historique:
revised:
28
07
2023
received:
13
04
2023
accepted:
08
08
2023
medline:
10
11
2023
pubmed:
11
8
2023
entrez:
11
8
2023
Statut:
ppublish
Résumé
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). 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. 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). 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.
Sections du résumé
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.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3751-3760Investigateurs
Guido Bigliardi
(G)
Paolo Cerrato
(P)
Valerio Da Ros
(V)
Nicola Limbucci
(N)
Sandra Bracco
(S)
Alessandro De Vito
(A)
Alfonsina Casalena
(A)
Davide Castellano
(D)
Ludovica Ferrau
(L)
Guido Andrea Lanzarotti
(GA)
Lucio Castellan
(L)
Umberto Scoditti
(U)
Andrea Giorgianni
(A)
Lucia Princiotta
(L)
Maria Ruggiero
(M)
Marco Longoni
(M)
Nicola Cavasin
(N)
Adriana Critelli
(A)
Simone Comelli
(S)
Maurizio Melis
(M)
Elvis Lafe
(E)
Anna Cavallini
(A)
William Auteri
(W)
Furio Stancati
(F)
Rosa Napoletano
(R)
Mauro Plebani
(M)
Alessio Comai
(A)
Enrica Franchini
(E)
Luca Allegretti
(L)
Tiziana Tassinari
(T)
Luigi Chiumarulo
(L)
Marco Petruzzellis
(M)
Alessandro Pedicelli
(A)
Giovanni Frisullo
(G)
Luigi Simonetti
(L)
Marco Pavia
(M)
Paolo Invernizzi
(P)
Ivan Gallesio
(I)
Federica Sepe
(F)
Michele Besana
(M)
Alessia Giossi
(A)
Pietro Filuari
(P)
Simona Sacco
(S)
Nicola Burdi
(N)
Giovanni Boero
(G)
Paola Feraco
(P)
Silvio Piffer
(S)
Giuseppe Romano
(G)
Maria Federica Grasso
(MF)
Paolo Versace
(P)
Luciano Arcudi
(L)
Pietro Amistá
(P)
Monia Russo
(M)
Emilio Lozupone
(E)
Antonio Fasano
(A)
Francesco Florio
(F)
Vincenzo Inchignolo
(V)
Informations de copyright
© 2023 European Academy of Neurology.
Références
George MG, Tong X, Bowman BA. Prevalence of cardiovascular risk factors and strokes in younger adults. JAMA Neurol. 2017;74(6):695-703. doi:10.1001/jamaneurol.2017.0020
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. The Lancet. 2016;387(10029):1723-1731. doi:10.1016/S0140-6736(16)00163-X
Brouwer J, Smaal JA, Emmer BJ, et al. Endovascular Thrombectomy in young patients with stroke: a MR CLEAN registry study. Stroke. 2022;53(1):34-42. doi:10.1161/STROKEAHA.120.034033
Chalouhi N, Tjoumakaris S, Starke RM, et al. Endovascular stroke intervention in young patients with large vessel occlusions. Neurosurg Focus. 2014;36(1):E6. doi:10.3171/2013.9.FOCUS13398
Putaala J, Metso AJ, Metso TM, et al. Analysis of 1008 consecutive patients aged 15 to 49 with first-ever ischemic stroke. Stroke. 2009;40(4):1195-1203. doi:10.1161/STROKEAHA.108.529883
von Sarnowski B, Putaala J, Grittner U, et al. Lifestyle risk factors for ischemic stroke and transient ischemic attack in young adults in the stroke in young Fabry patients study. Stroke. 2013;44(1):119-125. doi:10.1161/STROKEAHA.112.665190
Putaala J, Yesilot N, Waje-Andreassen U, et al. Demographic and geographic vascular risk factor differences in European young adults with ischemic stroke. Stroke. 2012;43(10):2624-2630. doi:10.1161/STROKEAHA.112.662866
Mangiafico S, Pracucci G, Saia V, et al. The Italian registry of endovascular treatment in acute stroke: rationale, design and baseline features of patients. Neurol Sci. 2015;36(6):985-993. doi:10.1007/s10072-014-2053-5
Toni D, Cappellari M, Caso V, et al. Italian Stroke Association guidelines. 2022 Accessed February 6, 2022. https://isa-aii.com/trombectomia-endovascolare-soci/
Turc G, Bhogal P, Fischer U, et al. European stroke organisation (ESO) - European Society for Minimally Invasive Neurological Therapy (ESMINT) guidelines on mechanical Thrombectomy in acute Ischaemic StrokeEndorsed by stroke Alliance for Europe (SAFE). Eur Stroke J. 2019;4(1):6-12. doi:10.1177/2396987319832140
Mangiafico S, Consoli A, Renieri L, et al. Semi-quantitative and qualitative evaluation of pial leptomeningeal collateral circulation in acute ischemic stroke of the anterior circulation: the Careggi collateral score. Ital J Anat Embryol. 2013;118(3):277-287. http://www.ncbi.nlm.nih.gov/pubmed/24640591
Higashida RT, Furlan AJ, Roberts H, et al. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke. 2003;34(8):e109-e137. doi:10.1161/01.STR.0000082721.62796.09
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). The Lancet. 1998;352(9136):1245-1251. doi:10.1016/S0140-6736(98)08020-9
Ekker MS, Verhoeven JI, Vaartjes I, van Nieuwenhuizen KM, Klijn CJM, de Leeuw FE. Stroke incidence in young adults according to age, subtype, sex, and time trends. Neurology. 2019;92(21):e2444-e2454. doi:10.1212/WNL.0000000000007533
Borggrefe J, Glück B, Maus V, et al. Clinical outcome after mechanical Thrombectomy in patients with diabetes with major ischemic stroke of the anterior circulation. World Neurosurg. 2018;120:e212-e220. doi:10.1016/j.wneu.2018.08.032
Lau L, Lew J, Borschmann K, Thijs V, Ekinci EI. Prevalence of diabetes and its effects on stroke outcomes: a meta-analysis and literature review. J Diabetes Investig. 2019;10(3):780-792. doi:10.1111/jdi.12932
Szmygin M, Sojka M, Tarkowski P, et al. Predictors of favorable outcome after endovascular thrombectomy for acute ischemic stroke due to large vessel occlusion in young patients. Acta Radiol. 2021;63(12):1689-1694. doi:10.1177/02841851211056476
Mistry EA, Mistry AM, Nakawah MO, et al. Mechanical Thrombectomy outcomes with and without intravenous thrombolysis in stroke patients: a meta-analysis. Stroke. 2017;48(9):2450-2456. doi:10.1161/STROKEAHA.117.017320
Fahey M, Crayton E, Wolfe C, Douiri A. Clinical prediction models for mortality and functional outcome following ischemic stroke: a systematic review and meta-analysis. PloS One. 2018;13(1):1-13. doi:10.1371/journal.pone.0185402
Toni D, Ahmed N, Anzini A, et al. Intravenous thrombolysis in young stroke patients: results from the SITS-ISTR. Neurology. 2012;78(12):880-887. doi:10.1212/WNL.0b013e31824d966b
Aarnio K, Joensuu H, Haapaniemi E, et al. Cancer in young adults with ischemic stroke. Stroke. 2015;46(6):1601-1606. doi:10.1161/STROKEAHA.115.008694
Nie X, Pu Y, Zhang Z, Liu X, Duan W, Liu L. Futile recanalization after endovascular therapy in acute ischemic stroke. Biomed Res Int. 2018;2018:1-5. doi:10.1155/2018/5879548
Deng G, Xiao J, Yu H, et al. Predictors of futile recanalization after endovascular treatment in acute ischemic stroke: a meta-analysis. J Neurointerv Surg. 2022;14(9), 881-885. doi:10.1136/neurintsurg-2021-017963
Hussein HM, Saleem MA, Qureshi AI. Rates and predictors of futile recanalization in patients undergoing endovascular treatment in a multicenter clinical trial. Neuroradiology. 2018;60(5):557-563. doi:10.1007/s00234-018-2016-2
Almekhlafi MA, Davalos A, Bonafe A, et al. Impact of age and baseline NIHSS scores on clinical outcomes in the mechanical thrombectomy using solitaire FR in acute ischemic stroke study. Am J Neuroradiol. 2014;35(7):1337-1340. doi:10.3174/ajnr.A3855
Cappellari M, Saia V, Pracucci G, et al. Association of the Careggi Collateral Score with 3-month modified Rankin scale score after thrombectomy for stroke with occlusion of the middle cerebral artery. J Neurol. 2022;269(2):1013-1023. doi:10.1007/s00415-021-10898-8
Alawieh A, Vargas J, Fargen KM, et al. Impact of procedure time on outcomes of Thrombectomy for stroke. J Am Coll Cardiol. 2019;73(8):879-890. doi:10.1016/j.jacc.2018.11.052
Enomoto Y, Uchida K, Yamagami H, et al. Impact of procedure time on clinical outcomes of patients who underwent endovascular therapy for acute ischemic stroke. Cerebrovasc Dis. 2021;50(4):443-449. doi:10.1159/000515260
Kaesmacher J, Dobrocky T, Heldner MR, et al. Systematic review and meta-analysis on outcome differences among patients with TICI2b versus TICI3 reperfusions: success revisited. J Neurol Neurosurg Psychiatry. 2018;89(9):910-917. doi:10.1136/jnnp-2017-317602
Casetta I, Fainardi E, Saia V, et al. Endovascular Thrombectomy for acute ischemic stroke beyond 6 hours from onset. Stroke. 2020;51(7):2051-2057. doi:10.1161/STROKEAHA.119.027974