Endovascular thrombectomy in young patients with large vessel occlusion stroke: a systematic review and meta-analysis

Data on endovascular thrombectomy (EVT) in young stroke patients due to large vessel occlusion (LVO) are limited. This systematic review and meta-analysis aim to compare the safety and efficacy of EVT in young patients (˂50 years) compared to older patients (≥ 50 years). A comprehensive literature search was conducted based on PubMed, EMBASE, and the Cochrane Library. We included studies that directly compared clinical outcomes of EVT in young patients and older patients. Random-effects meta-analyses were performed to measure functional independence (modified Rankin Scale [mRS] score 0-2 at 90 days), successful recanalization (expanded TICI [eTICI] score ≥ 2b) rates, symptomatic intracranial hemorrhage (sICH) rates, and mortality at 90 days. A total of three studies were included, encompassing 11,575 patients. The pooled analysis demonstrated that EVT significantly improved functional independence (OR = 2.47; 95% CI, 1.83-3.33; P < 0.00001) and reduced mortality (OR = 0.29; 95% CI, 0.09-0.90; P = 0.03) in young patients, compared to older patients. Recanalization rates were higher than older patients (OR = 1.22; 95% CI, 1.02-1.46; P = 0.03). Symptomatic intracranial hemorrhage occurred in 3.37% of young patients (30/889) and 4.50% of older patients (481/10686) (OR = 0.67; 95% CI, 0.45-0.98; P = 0.04). Endovascular thrombectomy is effective and safe in young patients with LVO stroke, leading to improved clinical outcomes, compared with older patients.