title: Endovascular stroke intervention in young patients with large vessel occlusions.
abstract: OBJECTIVE
  Endovascular therapy has become a widely used method for achieving arterial recanalization in patients who are ineligible for intravenous thrombolysis or those in whom it is unsuccessful. Young stroke patients with large vessel occlusions may particularly benefit from endovascular intervention. This study aims to assess the authors' experience with the use of modern endovascular techniques to treat young patients (≤ 55 years old) with acute ischemic stroke and large vessel occlusions.
  
  
  METHODS
  Young patients (≤ 55 years old) undergoing endovascular intervention for acute ischemic stroke at the authors' institution were identified from a prospectively maintained database. Only those patients with a confirmed large vessel occlusion were included. Modified Rankin Scale (mRS) scores were determined at 90 days during a follow-up visit. A multivariate analysis was performed to determine predictors of outcome (mRS score 0-2).
  
  
  RESULTS
  A total of 45 patients met the inclusion criteria. The mean age of the patients in this series was 45 ± 9.6 years. The mean admission NIH Stroke Scale score was 14.1 ± 5 (median 13.5). Mechanical thrombectomy was performed using the Solitaire FR device in 13 (29%) patients and the Merci/Penumbra systems in 32 (71%) patients. The rate of successful recanalization (Thrombolysis In Myocardial Infarction [TIMI] scale Grade II-III) was 93% (42/45). Only 1 patient (2.2%) had a symptomatic intracranial hemorrhage following intervention. One patient (2.2%) sustained a vessel perforation intraoperatively. The rate of 90-day favorable outcome (mRS score 0-2) was 77.5% and the rate of 90-day satisfactory outcome (mRS score 0-3) was 90%. The 90-day mortality rate was 7.5%. In multivariate analysis, postprocedure TIMI grade was the only statistically significant independent predictor of 90-day outcome (OR 3.3, 95% CI 1.01-1.19; p = 0.05).
  
  
  CONCLUSIONS
  The results of this study demonstrate that endovascular therapy provides remarkably high rates of arterial recanalization and favorable outcomes in young patients with acute ischemic stroke and large vessel occlusions. These findings support aggressive interventional strategies in these patients. Randomized, controlled trials reflecting modern acute ischemic stroke treatment will be needed to confirm the findings of this study.
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania;
authors.forename: Nohra
authors.initials: N
authors.lastname: Chalouhi
authors.forename: Stavropoula
authors.initials: S
authors.lastname: Tjoumakaris
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.forename: David
authors.initials: D
authors.lastname: Hasan
authors.forename: Nimrita
authors.initials: N
authors.lastname: Sidhu
authors.forename: Saurabh
authors.initials: S
authors.lastname: Singhal
authors.forename: Shannon
authors.initials: S
authors.lastname: Hann
authors.forename: L Fernando
authors.initials: LF
authors.lastname: Gonzalez
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenwasser
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
mesh_terms: D000328:Adult; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D002545:Brain Ischemia / Q000150:complications; D002561:Cerebrovascular Disorders / Q000601:surgery*; D003625:Data Collection; D003627:Data Interpretation, Statistical; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000209:etiology / Q000601:surgery*; D017131:Thrombectomy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D010959:Tissue Plasminogen Activator