Deans' stroke musings: Endovascular thrombectomy in young patients with stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Friday, August 12, 2022

Endovascular thrombectomy in young patients with stroke

Even young patients have to deal with the tyranny of low expectations; measuring 'good outcome'. NOT 100% RECOVERY. Until we beat into stroke researcher brains that the only goal in stroke to be measured is 100% RECOVERY, nothing will ever get stroke solved.

Endovascular thrombectomy in young patients with stroke

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Johannes M. Weller

, Franziska Dorn, Julius N. Meißner

, ...

First Published August 1, 2022 Research Article

Abstract

Background:

Endovascular treatment (ET) is standard of care(NOT RECOVERY!) in patients with acute ischemic stroke due to large vessel occlusion, but data on ET in young patients remain limited.

Aim:

To compare outcomes for young stroke patients undergoing ET in a matched cohort.

Methods:

We analyzed patients from an observational multicenter cohort with acute ischemic stroke and endovascular treatment, the German Stroke Registry – Endovascular Treatment trial. Baseline characteristics, procedural parameters and functional outcome at 90 days were compared between young (<50 years) and older (≥50 years) patients with and without nearest-neighbour 1:1 propensity score matching.

Results:

Out of 6628 acute ischemic stroke patients treated with ET, 363 (5.5%) were young. Young patients differed with regard to prognostic outcome characteristics. Specifically, NIHSS at admission was lower (median 13, interquartile range [IQR] 8-17 vs. 15, IQR 9-19, p<0.001) and prestroke dependence was less frequent (2.9 vs 12.2%, p<0.001) than in older patients. Compared to a matched cohort of older patients, ET was faster (time from groin puncture to flow restoration, 35 vs. 45 min, p<0.001) and intracranial hemorrhage was less frequent in young patients (10.0 vs 25.9%, p<0.001). Good functional outcome (mRS 0-2) at 3 months was achieved more frequently in young patients (71.6% vs. 44.1%, p<0.001), and overall mortality was lower (6.7 vs. 25.4%, p<0.001). Among previously employed young patients (n=177), 37.9% returned to work at 3-month follow-up, while 74.1% of the remaining patients were still undergoing rehabilitation.

Conclusion:

Young stroke patients undergoing ET have better outcomes compared to older patients, even when matched for prestroke condition, comorbidities and stroke severity. Hence, more liberal guidelines to perform ET for younger patients may have to be established by future studies.

Keywords

Stroke, Endovascular Therapy, mechanical thrombectomy, juvenile stroke, ischemic stroke, Therapy