Endovascular thrombectomy in young patients with acute vertebrobasilar artery occlusion

Data on endovascular thrombectomy (EVT) for acute vertebrobasilar artery occlusion (VBAO) in young adults are limited. We compared clinical characteristics and outcomes after EVT between young and older patients.

Using a multicenter retrospective registry, we analyzed patients undergoing EVT for acute VBAO. Patients were dichotomized by age (18-44 years vs ≥ 45 years). Primary outcomes were functional independence (modified Rankin Scale score, mRS 0-2) at 90 days and 1 year. Secondary outcomes included successful reperfusion, 24-hour/discharge National Institute of Health Stroke Scale (NIHSS) scores, early neurological function changes, 90-day/1-year mRS distributions, symptomatic intracranial hemorrhage (sICH), and mortality. Multivariable logistic regression adjusted for confounders assessed associations. Interaction effects between age group and hypertension/diabetes/atrial fibrillation were evaluated.

Among 518 patients, 37 (7.1%) were aged 18-44 years. Young patients had fewer cardiovascular comorbidities. Etiologies were more heterogeneous in young patients (large-artery atherosclerosis: 35.1%, other determined cause: 35.1%). Young patients more frequently achieved early neurological improvement and functional independence at 90 days and 1 year (unadjusted). Adjusted analyses showed age dichotomization was not significantly associated with 90-day (aOR 1.15, 95% CI 0.50-2.64, p = 0.74) or 1-year (aOR 1.59, 95% CI 0.68-3.72, p = 0.286) functional independence. A significant hypertension-by-age interaction existed for 90-day functional independence (p = 0.014), and no significant interactions were found for other comorbidities or at 1 year. Mortality and sICH rates were comparable between the two groups.

EVT demonstrates comparable efficacy in young and older VBAO patients, underscoring its critical value especially for young patients with more heterogeneous etiologies.