Cleveland Clinic Foundation, USA.
Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Neurological Institute - Center for Outcomes Research & Evaluation, USA.
J Stroke Cerebrovasc Dis. 2024 Dec;33(12):108027. doi: 10.1016/j.jstrokecerebrovasdis.2024.108027. Epub 2024 Sep 21.
Large vessel occlusion-acute ischemic stroke (LVO-AIS) is infrequent in young adults and exhibits distinct stroke mechanisms compared to older adults. This study sought to evaluate the impact of varying stroke etiologies on treatment-related outcomes in young adults with LVO-AIS, an aspect that remains unclear.
This retrospective cohort study included patients aged 18-50 presenting with AIS from January 2017 to December 2021 within our multi-center stroke network. Patients with LVO on CTA/MRA at presentation were included. We assessed demographics, stroke etiology (TOAST classification), and treatment-related outcomes. Based on intervention received, patients were divided into 5 groups [IV-thrombolysis (IVT) only, Mechanical Thrombectomy (MT) only, IVT+MT, no treatment, unsuccessful MT].
Among 1210 AIS patients, 220 with LVO were included. The median age was 42 (36, 46). 75 (34.1 %) patients underwent successful MT (46.7 % received IVT+MT). 26 (11.8 %) received IVT only, 110 (50 %) received neither intervention, and 9 (4.1 %) underwent unsuccessful MT. Per TOAST, 17.4 % had large artery atherosclerosis (LAA), 19.2 % cardio-embolism, 28.6 % stroke of other etiology, and 34.7 % had undetermined etiology. Favorable thrombectomy outcomes (TICI 2b/2c/3) were observed in 87.2 %. Discharge NIH Stroke Scale (NIHSS) scores improved for patients with IVT+MT in all TOAST categories except LAA.
Young adults with LVO-AIS had good outcomes irrespective of stroke etiology, except LAA, which was associated with a higher discharge NIHSS. Moreover, 50 % of young adults in our study received no intervention, a quarter of those owing to delayed presentation. Further studies are needed to identify barriers in seeking acute treatment in young adults with LVO-AIS.
大血管闭塞性急性缺血性卒中（LVO-AIS）在年轻患者中较为少见，与老年患者相比，其卒中机制存在显著差异。本研究旨在评估不同卒中病因对年轻 LVO-AIS 患者治疗相关结局的影响，这方面的情况尚不清楚。
本回顾性队列研究纳入了 2017 年 1 月至 2021 年 12 月期间我们的多中心卒中网络中发病年龄为 18-50 岁的 AIS 患者。所有患者的 CTA/MRA 均提示存在 LVO。我们评估了患者的人口统计学特征、卒中病因（TOAST 分类）以及治疗相关结局。根据干预措施的不同，将患者分为 5 组[单独 IV 溶栓（IVT）、单独机械取栓（MT）、IVT+MT、未治疗、MT 不成功]。
在 1210 例 AIS 患者中，纳入了 220 例 LVO 患者。患者的中位年龄为 42（36，46）岁。75 例（34.1%）患者成功接受 MT（46.7%接受了 IVT+MT）。26 例（11.8%）患者仅接受了 IVT，110 例（50%）患者未接受任何干预，9 例（4.1%）患者的 MT 不成功。按照 TOAST 分类，17.4%的患者为大动脉粥样硬化（LAA），19.2%的患者为心源性栓塞，28.6%的患者为其他病因引起的卒中，34.7%的患者病因不明。除 LAA 外，所有 TOAST 分类的患者接受 IVT+MT 治疗后均有良好的取栓结局（TICI 2b/2c/3）。除 LAA 外，接受 IVT+MT 治疗的患者出院时 NIHSS 评分均有所改善。
无论卒中病因如何，年轻的 LVO-AIS 患者的结局均较好，除了 LAA 患者，他们的出院 NIHSS 评分更高。此外，我们研究中有 50%的年轻患者未接受任何干预，其中四分之一是由于就诊延迟所致。需要进一步研究以确定年轻的 LVO-AIS 患者在寻求急性治疗方面的障碍。
