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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Outcomes of young patients following mechanical thrombectomy for stroke: A systematic review and meta-analysis
Hassan Kobeissi1, Michael Liu2, Sherief Ghozy3
1367854College of Medicine, Central Michigan University, Mt. Pleasant, MI, USA.
Insights
Young patients undergoing mechanical thrombectomy for acute ischemic stroke (AIS) show favorable outcomes. This systematic review found high rates of functional independence and successful reperfusion, with low mortality and symptomatic intracerebral hemorrhage risks.
Area of Science:
- Neurology
- Interventional Neurology
- Stroke Medicine
Background:
- Acute ischemic stroke (AIS) is less common in young patients compared to older adults.
- Mechanical thrombectomy is a key treatment for AIS.
- Outcomes in young AIS patients undergoing mechanical thrombectomy require detailed assessment.
Purpose of the Study:
- To systematically review and meta-analyze the outcomes and clinical characteristics of young stroke patients treated with mechanical thrombectomy for AIS.
- To evaluate functional independence, reperfusion rates, symptomatic intracerebral hemorrhage (sICH), and mortality in this cohort.
Main Methods:
- Systematic literature review following PRISMA guidelines across PubMed, MEDLINE, and Embase.
- Inclusion of eight studies comprising 1903 young patients (defined as 18-65 years).
- Pooled analysis of 90-day modified Rankin Scale (mRS) 0-2, successful reperfusion (TICI 2b/3), sICH, and mortality using R software.
Main Results:
- Functional independence (mRS 0-2) was achieved by 62.0% of young patients.
- Successful reperfusion (TICI 2b/3) rates were high at 82.0%.
- Mortality was 9.0%, and symptomatic intracerebral hemorrhage (sICH) rates were 5.7%.
Conclusions:
- Mechanical thrombectomy for AIS in young patients (18-65 years) is associated with high functional independence and successful reperfusion rates.
- The procedure demonstrated low rates of mortality and symptomatic intracerebral hemorrhage in this demographic.
- Further research is warranted to enhance understanding and inform clinical practice for young AIS patients receiving mechanical thrombectomy.
Background:
Young patients experience acute ischemic stroke (AIS) at much lower rates than their older counterparts. We performed a systematic review and meta-analysis to assess the question regarding outcomes and clinical characteristics of young stroke patients who underwent mechanical thrombectomy for AIS.
Methods:
Following PRISMA guidelines, a systematic review of the literature was conducted using the databases PubMed, MEDLINE, and Embase. The primary outcome of interest was 90-day modified Rankin Scale (mRS) 0-2. Secondary outcome variables included rate of successful reperfusion (TICI 2b/3), symptomatic intracerebral hemorrhage (sICH), and mortality. Using R software version 4.1.2, we calculated pooled event rates and their corresponding 95% confidence intervals (CI) for all outcomes.
Results:
Our analysis included eight studies with a total of 1903 patients. Definitions of young patients included age ranges of 18-49/50 years, 18-54/55 years, and 18-64/65 years. Functional independence was achieved in 62.0% of the patients, with an overall mortality of 9.0%. Moreover, successful reperfusion was achieved in 82.0% of the patients with sICH rates of 5.7%. There was significant heterogeneity among different analyses, which could not be attributed to the differences of the definition of young patients.
Conclusions:
Following mechanical thrombectomy for AIS, patients aged 18-65 years achieved relatively high rates of functional independence and successful reperfusion and low rates of mortality and sICH.Clinical Perspective In this systematic review and meta-analysis of eight studies, we examined outcomes in young stroke patients, aged 18-65 years old, following mechanical thrombectomy for acute ischemic stroke. We found that young patients achieved high rates of functional independence, high rates of successful reperfusion, and low rates of mortality and symptomatic intracerebral hemorrhage.While there have been several papers examining outcomes following mechanical thrombectomy for acute ischemic stroke in young patients, the results of these studies have yet to be pooled together in a meta-analysis. Our results indicate that young patients have good outcomes following mechanical thrombectomy. Further studies that examine these outcomes are warranted so that a higher-powered analysis can be performed to better informed clinicians regarding outcomes in this patient age-group cohort.
