Effect of Stroke Etiology on Mechanical Thrombectomy Outcomes in Young Adults: A Retrospective Data Analysis (P8-5.021)

Abstract

<h3>Objective:</h3> We sought to study mechanical thrombectomy (MT) outcomes in racially diverse young adult patients with large vessel occlusion-acute ischemic stroke (LVO-AIS) presenting to the Cleveland Clinic Stroke Enterprise, and assess if stroke etiology affected MT outcome. <h3>Background:</h3> LVO-AIS is considerably uncommon in young adults. They also have distinctively different stroke mechanisms. The data on whether varying etiologies in this age-group influence MT outcomes is unclear. <h3>Design/Methods:</h3> This retrospective study cohort comprised of patients 18–50 years of age, presenting with AIS from January 2017 to December 2021. Patients with LVO on CTA or MRA at presentation were included. We assessed demographics, stroke etiology (TOAST and ASCOD classifications), intervention received (IV-thrombolysis+/−MT) and MT outcomes. <h3>Results:</h3> Out of 1210 patients with AIS, 210 with LVO were included. 88 (41.9%) underwent MT (44.3% received IV-thrombolysis+ MT). 21 (10%) patients received only IV-thrombolysis; 101 (48.1%) received neither intervention. Among patients who underwent MT, median (IQR 25,75) age was 42 (36,46) years, 46.6% were females, 70.5% identified as “white”. Median iNIHSS was 12 (7.75,18.25); 78.3% had initial mRS 0. Median last known well to groin puncture time was 6.75 hours. 92% patients had favorable outcome (TICI 2b/2c/3). Median discharge NIHSS was 1.5 (0,7.5). Discharge mRS: 1 for 33% with large-artery atherosclerosis (LAA), 1 for 31.6% with cardio-embolism, 0 for 71.4% with stroke of other etiology, 0/1 for 45% of undetermined etiology. Our cohort’s stroke etiology- Per TOAST: 13.6% LAA, 0% small vessel disease (SVD), 29.5% cardio-embolism, 25% stroke of other etiology, 33% undetermined etiology. Per ASCOD: 31.8% LAA, 4.4% SVD, 45.4% cardiac, 13.6% other causes, 11.4% vessel dissection. <h3>Conclusions:</h3> In our cohort, a high proportion of patients were functionally independent after MT, with good outcome independent of stroke etiology. A large proportion of patients received no acute intervention. Further studies are needed to identify barriers to this in young adults. <b>Disclosure:</b> Dr. Bhayana has nothing to disclose. Dr. Handshoe has nothing to disclose. Dr. Chandra has nothing to disclose. Dr. Martucci has nothing to disclose. Mr. Reid has nothing to disclose. Miss Kharal has nothing to disclose. Miss A Saleem has nothing to disclose. Mr. Saleem has nothing to disclose. Andrew Schuster has nothing to disclose. Dr. Hussain has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cerenovus. Dr. Hussain has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Tiger Medical. Dr. Toth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Dynamed. Dr. Toth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Microvention. Dr. Toth has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. Dr. Kharal has nothing to disclose.