Abstract TP82: Effect of Stroke Etiology and Treatment Intervention for Young Adults With Large Vessel Occlusion- Acute Ischemic Stroke: Results From the Cleveland Clinic Young Adult Retrospective Cohort Study

Abstract

Introduction: The incidence of Large Vessel Occlusion-Acute Ischemic Stroke (LVO-AIS) continues to increase in young adults. Although young adults who undergo mechanical thrombectomy have favorable outcomes, it is unclear if stroke etiology affects rehabilitation outcomes & discharge destination for these patients. Hypothesis: Large artery atherosclerosis (LAA) results in worse outcomes as compared to other etiologies in terms of discharge destination. Methods: This retrospective study cohort comprised of patients 18-50 years of age, presenting to the Cleveland Clinic Stroke Enterprise, with LVO-AIS from January 2017 to December 2021. Patients with LVO on CTA or MRA at presentation were included. We then assessed patients with LAA and compared their discharge destination to patients with other etiologies. Results: Out of 1210 patients with AIS, 172 with LVO were included. 31 patients (18%) had stroke etiology as Large Artery Atherosclerosis (per TOAST criteria). Among patients with LAA, the median initial NIHSS was 6 and median discharge NIHSS 4. 16.2% of these patients received IV thrombolysis and 32.4% underwent mechanical thrombectomy (MT). 48.4% patients were discharged to acute rehabilitation, 32.3% went home, 12.9% SNF, and 6.5% deceased. In contrast, patients for whom TOAST criteria was not “Large Artery Atherosclerosis”, had a median initial NIHSS 9 and median discharge NIHSS 2. 31.2% received IV thrombolysis and 43.9% underwent MT. Their discharge destination was home for 56%, acute rehabilitation for 27.7%, LTAC for 5%, 2.8% SNF, and 8.5% deceased. Both these groups had similar initial mRS. Conclusions: Young adults with LVO-AIS had good outcomes irrespective of stroke etiology, however LAA patients were less likely to be discharged home compared to other etiologies, likely owing to less functional recovery as compared to other etiologies. Further studies are needed to determine why young adults with LVO with LAA have worse outcomes.