Outcomes in young adults with acute ischemic stroke undergoing endovascular thrombectomy: a real-world multi-center experience.

BACKGROUND Endovascular thrombectomy (EVT) is 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. METHODS All consecutive AIS-LVO patients aged 50 years old and below were included in this multi-center cohort study. The primary outcome measured was functional recovery at 90 days, with modified Rankin Scale of 0-2 deemed as good functional outcome. RESULTS 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 Institute of Health Stroke Scale (NIHSS) score at presentation was inversely related with 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 (aOR0.14, 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). 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.