Abstract
Introduction: Endovascular thrombectomy(EVT) is considered standard of care for anterior circulation acute ischemic stroke(AIS) with large vessel occlusion(LVO). Young AIS-LVO patients have distinctly different underlying stroke mechanisms and etiologies. Methods: In this multicenter cohort study conducted from August 2014 to January 2020, we investigated the safety and effectiveness of EVT in young AIS-LVO patients aged≤50 years and evaluated associations between demographics, stroke etiology, neuroimaging factors and clinical outcomes, including functional outcomes, in-hospital mortality and symptomatic intracranial haemorrhage(sICH) in univariable and multivariable regression models. Results: 275 AIS-LVO patients from 10 tertiary centers in Germany, Sweden, Singapore and Taiwan were included. The more common TOAST subtypes included cardioembolism (82/275, 29.8%) and stroke of undetermined etiology (85/275, 30.9%). Arterial dissection was the most prevalent stroke etiology (42/195, 21.5%) and had the highest rate of good functional outcomes (29/42, 69.0%). Successful reperfusion was achieved in 85.1% (234/275). Excellent and good functional outcomes were achieved in 48.0% (132/275) and 66.0% (182/275) respectively. sICH occurred in 6.5% (18/275). National Institute of Health Stroke Scale (NIHSS) at presentation was inversely related with good functional outcomes (aOR0.92, 95% CI 0.88- 0.96 per point increase, p<0.001). Successful reperfusion (aOR3.22, 95% CI 1.44-7.21, p=0.005), higher ASPECTS (aOR1.21, 95% CI 1.01-1.44, p=0.036) and bridging intravenous thrombolysis (aOR2.37, 95% CI 1.29-4.34, p=0.005) independently predicted good functional outcomes. Higher initial NIHSS (aOR1.08, 95% 1.02-1.14, p=0.007) and lower ASPECTS (aOR0.73, 95% 0.58-0.93, p=0.012) were associated with sICH. Successful reperfusion was inversely associated with in-hospital mortality (aOR0.14, 95% CI 0.03-0.57, p=0.006). Hypertension strongly predicted in-hospital mortality (aOR4.59, 95% CI 1.10-19.13, p=0.036). Conclusion: 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.
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