Endovascular Thrombectomy in Young Patients With Stroke: A MR CLEAN Registry Study
Acute ischemic stroke due to large vessel occlusion is uncommon in young adults. We assessed stroke cause in young patients and compared their outcomes after endovascular thrombectomy with older patients. We used data (March 2014 until November 2017) of patients with an anterior circulation large ve...
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| Veröffentlicht in: | Stroke (1970) 2022-01, Vol.53 (1), p.34-42 |
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| creator | Brouwer, Josje Smaal, Johanna A. Emmer, Bart J. de Ridder, Inger R. van den Wijngaard, Ido R. de Leeuw, Frank-Erik Hofmeijer, Jeannette van Zwam, Wim H. Martens, Jasper M. Roos, Yvo B.W.E.M. Majoie, Charles B. van Oostenbrugge, Robert J. Coutinho, Jonathan M. |
| description | Acute ischemic stroke due to large vessel occlusion is uncommon in young adults. We assessed stroke cause in young patients and compared their outcomes after endovascular thrombectomy with older patients.
We used data (March 2014 until November 2017) of patients with an anterior circulation large vessel occlusion stroke from the MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry, a nationwide, prospective study on endovascular thrombectomy in the Netherlands. We compared young patients (18-49 years) with older patients (≥50 years). Outcomes included modified Rankin Scale score after 90 days (both shift and dichotomized analyses), expanded Thrombolysis in Cerebral Infarction score, and symptomatic intracranial hemorrhage. Analyses were adjusted for confounding.
We included 3256 patients, 310 (10%) were 18 to 49 years old. Young patients had lower median National Institutes of Health Stroke Scale scores (14 versus 16, |
| doi_str_mv | 10.1161/STROKEAHA.120.034033 |
| format | Article |
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We used data (March 2014 until November 2017) of patients with an anterior circulation large vessel occlusion stroke from the MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry, a nationwide, prospective study on endovascular thrombectomy in the Netherlands. We compared young patients (18-49 years) with older patients (≥50 years). Outcomes included modified Rankin Scale score after 90 days (both shift and dichotomized analyses), expanded Thrombolysis in Cerebral Infarction score, and symptomatic intracranial hemorrhage. Analyses were adjusted for confounding.
We included 3256 patients, 310 (10%) were 18 to 49 years old. Young patients had lower median National Institutes of Health Stroke Scale scores (14 versus 16,
<0.001) and less cardiovascular comorbidities than older patients. Stroke etiologies in young patients included carotid dissection (16%), cardio-embolism (15%), large artery atherosclerosis (10%), and embolic stroke of undetermined source (31%). Clinical outcome was better in young than older patients (acOR for modified Rankin Scale shift: 1.8 [95% CI, 1.5-2.2]; functional independence [modified Rankin Scale score 0-2] 61 versus 39% [adjusted odds ratio, 2.1 [95% CI, 1.6-2.8]); mortality 7% versus 32%, adjusted odds ratio, 0.2 [95% CI, 0.1-0.3]). Symptomatic intracranial hemorrhage occurred less frequently in young patients (3% versus 6%, adjusted odds ratio, 0.5 [95% CI, 0.2-1.00]). Successful reperfusion (expanded Thrombolysis in Cerebral Infarction Score 2b-3) did not differ between groups. Onset to reperfusion time was shorter in young patients (253 versus 255 minutes, adjusted B in minutes 12.4 [95% CI, 2.4-22.5]).
Ten percent of patients with acute ischemic stroke undergoing endovascular thrombectomy were younger than 50. Cardioembolism and carotid dissection were common underlying causes in young patients. In one-third of cases, no cause was identified, indicating the need for more research on stroke cause in young patients. Young patients had better prognosis and lower risk of symptomatic intracranial hemorrhage than older patients.</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/STROKEAHA.120.034033</identifier><identifier>PMID: 34872339</identifier><language>eng</language><publisher>United States: American Heart Association, Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Brain Ischemia - diagnosis ; Brain Ischemia - epidemiology ; Brain Ischemia - therapy ; Cohort Studies ; Endovascular Procedures - methods ; Endovascular Procedures - trends ; Female ; Humans ; Ischemic Stroke - diagnosis ; Ischemic Stroke - epidemiology ; Ischemic Stroke - therapy ; Male ; Middle Aged ; Netherlands - epidemiology ; Prospective Studies ; Registries ; Thrombectomy - methods ; Thrombectomy - trends ; Treatment Outcome</subject><ispartof>Stroke (1970), 2022-01, Vol.53 (1), p.34-42</ispartof><rights>American Heart Association, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3986-d8022a9553d2606dac7207e5516e08f77c0298239244a125e8c8fc4be3e045f13</citedby><cites>FETCH-LOGICAL-c3986-d8022a9553d2606dac7207e5516e08f77c0298239244a125e8c8fc4be3e045f13</cites><orcidid>0000-0003-2221-3026 ; 0000-0001-9205-5882 ; 0000-0003-1631-7056 ; 0000-0003-0301-2616 ; 0000-0002-7600-9568 ; 0000-0003-1222-0652 ; 0000-0002-7593-5674 ; 0000-0002-3734-6086 ; 0000-0003-1032-9099 ; 0000-0002-8284-982X ; 0000-0002-9418-4503</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34872339$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Brouwer, Josje</creatorcontrib><creatorcontrib>Smaal, Johanna A.</creatorcontrib><creatorcontrib>Emmer, Bart J.</creatorcontrib><creatorcontrib>de Ridder, Inger R.</creatorcontrib><creatorcontrib>van den Wijngaard, Ido R.</creatorcontrib><creatorcontrib>de Leeuw, Frank-Erik</creatorcontrib><creatorcontrib>Hofmeijer, Jeannette</creatorcontrib><creatorcontrib>van Zwam, Wim H.</creatorcontrib><creatorcontrib>Martens, Jasper M.</creatorcontrib><creatorcontrib>Roos, Yvo B.W.E.M.</creatorcontrib><creatorcontrib>Majoie, Charles B.</creatorcontrib><creatorcontrib>van Oostenbrugge, Robert J.</creatorcontrib><creatorcontrib>Coutinho, Jonathan M.</creatorcontrib><creatorcontrib>MR CLEAN Registry Investigators</creatorcontrib><creatorcontrib>on behalf of the MR CLEAN Registry Investigators</creatorcontrib><title>Endovascular Thrombectomy in Young Patients With Stroke: A MR CLEAN Registry Study</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>Acute ischemic stroke due to large vessel occlusion is uncommon in young adults. We assessed stroke cause in young patients and compared their outcomes after endovascular thrombectomy with older patients.
We used data (March 2014 until November 2017) of patients with an anterior circulation large vessel occlusion stroke from the MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry, a nationwide, prospective study on endovascular thrombectomy in the Netherlands. We compared young patients (18-49 years) with older patients (≥50 years). Outcomes included modified Rankin Scale score after 90 days (both shift and dichotomized analyses), expanded Thrombolysis in Cerebral Infarction score, and symptomatic intracranial hemorrhage. Analyses were adjusted for confounding.
We included 3256 patients, 310 (10%) were 18 to 49 years old. Young patients had lower median National Institutes of Health Stroke Scale scores (14 versus 16,
<0.001) and less cardiovascular comorbidities than older patients. Stroke etiologies in young patients included carotid dissection (16%), cardio-embolism (15%), large artery atherosclerosis (10%), and embolic stroke of undetermined source (31%). Clinical outcome was better in young than older patients (acOR for modified Rankin Scale shift: 1.8 [95% CI, 1.5-2.2]; functional independence [modified Rankin Scale score 0-2] 61 versus 39% [adjusted odds ratio, 2.1 [95% CI, 1.6-2.8]); mortality 7% versus 32%, adjusted odds ratio, 0.2 [95% CI, 0.1-0.3]). Symptomatic intracranial hemorrhage occurred less frequently in young patients (3% versus 6%, adjusted odds ratio, 0.5 [95% CI, 0.2-1.00]). Successful reperfusion (expanded Thrombolysis in Cerebral Infarction Score 2b-3) did not differ between groups. Onset to reperfusion time was shorter in young patients (253 versus 255 minutes, adjusted B in minutes 12.4 [95% CI, 2.4-22.5]).
Ten percent of patients with acute ischemic stroke undergoing endovascular thrombectomy were younger than 50. Cardioembolism and carotid dissection were common underlying causes in young patients. In one-third of cases, no cause was identified, indicating the need for more research on stroke cause in young patients. Young patients had better prognosis and lower risk of symptomatic intracranial hemorrhage than older patients.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Brain Ischemia - diagnosis</subject><subject>Brain Ischemia - epidemiology</subject><subject>Brain Ischemia - therapy</subject><subject>Cohort Studies</subject><subject>Endovascular Procedures - methods</subject><subject>Endovascular Procedures - trends</subject><subject>Female</subject><subject>Humans</subject><subject>Ischemic Stroke - diagnosis</subject><subject>Ischemic Stroke - epidemiology</subject><subject>Ischemic Stroke - therapy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Netherlands - epidemiology</subject><subject>Prospective Studies</subject><subject>Registries</subject><subject>Thrombectomy - methods</subject><subject>Thrombectomy - trends</subject><subject>Treatment Outcome</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkF1v0zAUhi0EYt3gHyDkS25Sjr9im7uoKmyi21BXhLiyXMdZw5J42A5T__0ytRvn5hzpvB_Sg9AHAnNCSvL5ZrO-_r6szqs5oTAHxoGxV2hGBOUFL6l6jWYATBeUa32CTlP6AwCUKfEWnTCuJGVMz9B6OdThn01u7GzEm10M_da7HPo9bgf8O4zDLf5hc-uHnPCvNu_wTY7hzn_BFb5c48VqWV3htb9tU4776TfW-3foTWO75N8f9xn6-XW5WZwXq-tvF4tqVTimVVnUCii1WghW0xLK2jpJQXohSOlBNVI6oFpRpinnllDhlVON41vPPHDREHaGPh1y72P4O_qUTd8m57vODj6MyUypUkhJFJuk_CB1MaQUfWPuY9vbuDcEzBNN80LTTDTNgeZk-3hsGLe9r19Mz_j-5z6ELvuY7rrxwUez87bLOzPxBllKKDQc5-miJXsEDaR-Tw</recordid><startdate>20220101</startdate><enddate>20220101</enddate><creator>Brouwer, Josje</creator><creator>Smaal, Johanna A.</creator><creator>Emmer, Bart J.</creator><creator>de Ridder, Inger R.</creator><creator>van den Wijngaard, Ido R.</creator><creator>de Leeuw, Frank-Erik</creator><creator>Hofmeijer, Jeannette</creator><creator>van Zwam, Wim H.</creator><creator>Martens, Jasper M.</creator><creator>Roos, Yvo B.W.E.M.</creator><creator>Majoie, Charles B.</creator><creator>van Oostenbrugge, Robert J.</creator><creator>Coutinho, Jonathan M.</creator><general>American Heart Association, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2221-3026</orcidid><orcidid>https://orcid.org/0000-0001-9205-5882</orcidid><orcidid>https://orcid.org/0000-0003-1631-7056</orcidid><orcidid>https://orcid.org/0000-0003-0301-2616</orcidid><orcidid>https://orcid.org/0000-0002-7600-9568</orcidid><orcidid>https://orcid.org/0000-0003-1222-0652</orcidid><orcidid>https://orcid.org/0000-0002-7593-5674</orcidid><orcidid>https://orcid.org/0000-0002-3734-6086</orcidid><orcidid>https://orcid.org/0000-0003-1032-9099</orcidid><orcidid>https://orcid.org/0000-0002-8284-982X</orcidid><orcidid>https://orcid.org/0000-0002-9418-4503</orcidid></search><sort><creationdate>20220101</creationdate><title>Endovascular Thrombectomy in Young Patients With Stroke: A MR CLEAN Registry Study</title><author>Brouwer, Josje ; Smaal, Johanna A. ; Emmer, Bart J. ; de Ridder, Inger R. ; van den Wijngaard, Ido R. ; de Leeuw, Frank-Erik ; Hofmeijer, Jeannette ; van Zwam, Wim H. ; Martens, Jasper M. ; Roos, Yvo B.W.E.M. ; Majoie, Charles B. ; van Oostenbrugge, Robert J. ; Coutinho, Jonathan M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3986-d8022a9553d2606dac7207e5516e08f77c0298239244a125e8c8fc4be3e045f13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Brain Ischemia - diagnosis</topic><topic>Brain Ischemia - epidemiology</topic><topic>Brain Ischemia - therapy</topic><topic>Cohort Studies</topic><topic>Endovascular Procedures - methods</topic><topic>Endovascular Procedures - trends</topic><topic>Female</topic><topic>Humans</topic><topic>Ischemic Stroke - diagnosis</topic><topic>Ischemic Stroke - epidemiology</topic><topic>Ischemic Stroke - therapy</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Netherlands - epidemiology</topic><topic>Prospective Studies</topic><topic>Registries</topic><topic>Thrombectomy - methods</topic><topic>Thrombectomy - trends</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Brouwer, Josje</creatorcontrib><creatorcontrib>Smaal, Johanna A.</creatorcontrib><creatorcontrib>Emmer, Bart J.</creatorcontrib><creatorcontrib>de Ridder, Inger R.</creatorcontrib><creatorcontrib>van den Wijngaard, Ido R.</creatorcontrib><creatorcontrib>de Leeuw, Frank-Erik</creatorcontrib><creatorcontrib>Hofmeijer, Jeannette</creatorcontrib><creatorcontrib>van Zwam, Wim H.</creatorcontrib><creatorcontrib>Martens, Jasper M.</creatorcontrib><creatorcontrib>Roos, Yvo B.W.E.M.</creatorcontrib><creatorcontrib>Majoie, Charles B.</creatorcontrib><creatorcontrib>van Oostenbrugge, Robert J.</creatorcontrib><creatorcontrib>Coutinho, Jonathan M.</creatorcontrib><creatorcontrib>MR CLEAN Registry Investigators</creatorcontrib><creatorcontrib>on behalf of the MR CLEAN Registry Investigators</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Brouwer, Josje</au><au>Smaal, Johanna A.</au><au>Emmer, Bart J.</au><au>de Ridder, Inger R.</au><au>van den Wijngaard, Ido R.</au><au>de Leeuw, Frank-Erik</au><au>Hofmeijer, Jeannette</au><au>van Zwam, Wim H.</au><au>Martens, Jasper M.</au><au>Roos, Yvo B.W.E.M.</au><au>Majoie, Charles B.</au><au>van Oostenbrugge, Robert J.</au><au>Coutinho, Jonathan M.</au><aucorp>MR CLEAN Registry Investigators</aucorp><aucorp>on behalf of the MR CLEAN Registry Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Endovascular Thrombectomy in Young Patients With Stroke: A MR CLEAN Registry Study</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>2022-01-01</date><risdate>2022</risdate><volume>53</volume><issue>1</issue><spage>34</spage><epage>42</epage><pages>34-42</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><abstract>Acute ischemic stroke due to large vessel occlusion is uncommon in young adults. We assessed stroke cause in young patients and compared their outcomes after endovascular thrombectomy with older patients.
We used data (March 2014 until November 2017) of patients with an anterior circulation large vessel occlusion stroke from the MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry, a nationwide, prospective study on endovascular thrombectomy in the Netherlands. We compared young patients (18-49 years) with older patients (≥50 years). Outcomes included modified Rankin Scale score after 90 days (both shift and dichotomized analyses), expanded Thrombolysis in Cerebral Infarction score, and symptomatic intracranial hemorrhage. Analyses were adjusted for confounding.
We included 3256 patients, 310 (10%) were 18 to 49 years old. Young patients had lower median National Institutes of Health Stroke Scale scores (14 versus 16,
<0.001) and less cardiovascular comorbidities than older patients. Stroke etiologies in young patients included carotid dissection (16%), cardio-embolism (15%), large artery atherosclerosis (10%), and embolic stroke of undetermined source (31%). Clinical outcome was better in young than older patients (acOR for modified Rankin Scale shift: 1.8 [95% CI, 1.5-2.2]; functional independence [modified Rankin Scale score 0-2] 61 versus 39% [adjusted odds ratio, 2.1 [95% CI, 1.6-2.8]); mortality 7% versus 32%, adjusted odds ratio, 0.2 [95% CI, 0.1-0.3]). Symptomatic intracranial hemorrhage occurred less frequently in young patients (3% versus 6%, adjusted odds ratio, 0.5 [95% CI, 0.2-1.00]). Successful reperfusion (expanded Thrombolysis in Cerebral Infarction Score 2b-3) did not differ between groups. Onset to reperfusion time was shorter in young patients (253 versus 255 minutes, adjusted B in minutes 12.4 [95% CI, 2.4-22.5]).
Ten percent of patients with acute ischemic stroke undergoing endovascular thrombectomy were younger than 50. Cardioembolism and carotid dissection were common underlying causes in young patients. In one-third of cases, no cause was identified, indicating the need for more research on stroke cause in young patients. Young patients had better prognosis and lower risk of symptomatic intracranial hemorrhage than older patients.</abstract><cop>United States</cop><pub>American Heart Association, Inc</pub><pmid>34872339</pmid><doi>10.1161/STROKEAHA.120.034033</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-2221-3026</orcidid><orcidid>https://orcid.org/0000-0001-9205-5882</orcidid><orcidid>https://orcid.org/0000-0003-1631-7056</orcidid><orcidid>https://orcid.org/0000-0003-0301-2616</orcidid><orcidid>https://orcid.org/0000-0002-7600-9568</orcidid><orcidid>https://orcid.org/0000-0003-1222-0652</orcidid><orcidid>https://orcid.org/0000-0002-7593-5674</orcidid><orcidid>https://orcid.org/0000-0002-3734-6086</orcidid><orcidid>https://orcid.org/0000-0003-1032-9099</orcidid><orcidid>https://orcid.org/0000-0002-8284-982X</orcidid><orcidid>https://orcid.org/0000-0002-9418-4503</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Stroke (1970), 2022-01, Vol.53 (1), p.34-42 |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection; Journals@Ovid Complete |
| subjects | Adult Aged Aged, 80 and over Brain Ischemia - diagnosis Brain Ischemia - epidemiology Brain Ischemia - therapy Cohort Studies Endovascular Procedures - methods Endovascular Procedures - trends Female Humans Ischemic Stroke - diagnosis Ischemic Stroke - epidemiology Ischemic Stroke - therapy Male Middle Aged Netherlands - epidemiology Prospective Studies Registries Thrombectomy - methods Thrombectomy - trends Treatment Outcome |
| title | Endovascular Thrombectomy in Young Patients With Stroke: A MR CLEAN Registry Study |
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