WSO - April 2023 - 453

1119602
WSO
International Journal of Stroke X(X)Weller et al.
Research
Endovascular thrombectomy in young
patients with stroke
Johannes M Weller1 , Franziska Dorn2, Julius N Meissner1
Sebastian Stösser1 , Niklas M Beckonert1, Julia Nordsiek1
,
,
Christine Kindler1, Milani Deb-Chatterji3 , Gabor C Petzold1
and Felix J Bode1 on behalf of the GSR-ET investigators
Abstract
Background: Endovascular treatment (ET) is standard of care in patients with acute ischemic stroke due to large vessel
occlusion, but data on ET in young patients remain limited.
Aim: We aim to compare outcomes for young stroke patients undergoing ET in a matched cohort.
Methods: We analyzed patients from an observational multicenter cohort with acute ischemic stroke and ET, the
German Stroke Registry-Endovascular Treatment trial. Baseline characteristics, procedural parameters, and functional
outcome at 90 days were compared between young (<50 years) and older (⩾50 years) patients with and without nearest-neighbor
1:1 propensity score matching.
Results: Out of 6628 acute ischemic stroke patients treated with ET, 363 (5.5%) were young. Young patients differed
with regard to prognostic outcome characteristics. Specifically, National Institutes of Health Stroke Scale (NIHSS) at
admission was lower (median 13, interquartile range (IQR) 8-17 vs. 15, IQR 9-19, p < 0.001), and prestroke dependence
was less frequent (2.9% vs. 12.2%, p < 0.001) than in older patients. Compared to a matched cohort of older patients, ET
was faster (time from groin puncture to flow restoration, 35 vs. 45 min, p < 0.001) and intracranial hemorrhage was less
frequent in young patients (10.0% vs. 25.9%, p < 0.001). Good functional outcome (modified Rankin Scale (mRS) 0-2) at
3 months was achieved more frequently in young patients (71.6% vs. 44.1%, p < 0.001), and overall mortality was lower
(6.7% vs. 25.4%, p < 0.001). Among previously employed young patients (n = 177), 37.9% returned to work at 3-month
follow-up, while 74.1% of the remaining patients were still undergoing rehabilitation.
Conclusion: Young stroke patients undergoing ET have better outcomes compared to older patients, even when
matched for prestroke condition, comorbidities, and stroke severity. Hence, more liberal guidelines to perform ET for
younger patients may have to be established by future studies.
Keywords
Stroke, endovascular therapy, mechanical thrombectomy, juvenile stroke, ischemic stroke, large vessel occlusion, clinical
outcome
Received: 8 June 2022; accepted: 25 July 2022
Introduction
Endovascular treatment (ET) is the standard therapy for
patients with acute ischemic stroke (AIS) and large vessel
occlusion (LVO).1-3 Stroke mainly affects elderly patients,
and this is reflected by most ET trials, with a median age
ranging from 68 years in the HERMES trials to 75 years in
clinical registries.1,4 In addition, stroke due to LVO is relatively
rare in young patients, further limiting available data
on ET in this cohort.5 As a result, the benefit of ET in
1 Division of Vascular Neurology, Department of Neurology, University
Hospital Bonn, Bonn, Germany
2 Department of Neuroradiology, University Hospital Bonn, Bonn,
Germany
3 Department of Neurology, University Hospital Hamburg-Eppendorf,
Hamburg, Germany
Corresponding author:
Johannes M Weller, Division of Vascular Neurology, Department of
Neurology, University Hospital Bonn, Venusberg Campus 1, 53127
Bonn, Germany.
Email: Johannes.Weller@ukbonn.de
International Journal of Stroke, 18(4)
International Journal of Stroke
2023, Vol. 18(4) 453 -461
© 2022 World Stroke Organization
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DOI: 10.1177/17474930221119602
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