Endovascular treatment for young patients with acute large vessel occlusion stroke in China: analysis of the ANGEL-ACT registry
BackgroundThe incidence of acute ischemic stroke caused by large vessel occlusion is relatively infrequent in the young adult population. We sought to evaluate their clinical outcomes after endovascular treatment (EVT) and stroke etiology compared with older patients.MethodsWe examined data from the...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-10-01
|
| Series: | Frontiers in Neurology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1255043/full |
| _version_ | 1797654403771006976 |
|---|---|
| author | Bin Han Raynald Dapeng Sun Xu Tong Baixue Jia Anxin Wang Anxin Wang Dapeng Mo Feng Gao Ning Ma Thanh N. Nguyen Zhongrong Miao |
| author_facet | Bin Han Raynald Dapeng Sun Xu Tong Baixue Jia Anxin Wang Anxin Wang Dapeng Mo Feng Gao Ning Ma Thanh N. Nguyen Zhongrong Miao |
| author_sort | Bin Han |
| collection | DOAJ |
| description | BackgroundThe incidence of acute ischemic stroke caused by large vessel occlusion is relatively infrequent in the young adult population. We sought to evaluate their clinical outcomes after endovascular treatment (EVT) and stroke etiology compared with older patients.MethodsWe examined data from the ANGEL-ACT registry, a nationwide study in China focusing on EVT for acute ischemic stroke. We compared two age groups: <50 years old and ≥50 years old. Our analysis focused on outcome measures such as the 90-day modified Rankin Scale (mRS) score, mortality, and symptomatic intracranial hemorrhage (sICH). We adjusted for confounding variables.ResultsWe included 1,691 patients, and 216 patients (13%) were <50 years old. Young patients had lower median National Institutes of Health Stroke Scale (NIHSS) scores (14 vs. 17, P < 0.001) and fewer cardiovascular comorbidities than older patients. Underlying intracranial atherosclerosis disease (ICAD) was higher in young patients (39.4 vs. 28.7%, P = 0.001). Clinical outcome was less favorable in older compared to younger patients (mRS shift: 0.76 [95% confidence interval (CI), 0.58–0.99]); functional independence [mRS score 0–2] 61% vs. 39% (adjusted odds ratio (OR), 0.7 [95% CI, 0.51–0.97]). Mortality and sICH did not differ between groups. Onset to puncture time (OTP) was longer in young patients (357 min vs. 294 min, P = 0.001).ConclusionAn estimated 13% of patients who underwent endovascular thrombectomy for acute ischemic stroke were <50 years old. Symptomatic underlying ICAD was more prevalent in the younger patient population. Despite a prehospital delay, younger patients exhibited more favorable outcomes than their older counterparts. |
| first_indexed | 2024-03-11T16:59:02Z |
| format | Article |
| id | doaj.art-205a2585670747d1949ab01b636af1cd |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-03-11T16:59:02Z |
| publishDate | 2023-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-205a2585670747d1949ab01b636af1cd2023-10-20T12:55:41ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-10-011410.3389/fneur.2023.12550431255043Endovascular treatment for young patients with acute large vessel occlusion stroke in China: analysis of the ANGEL-ACT registryBin Han0 Raynald1Dapeng Sun2Xu Tong3Baixue Jia4Anxin Wang5Anxin Wang6Dapeng Mo7Feng Gao8Ning Ma9Thanh N. Nguyen10Zhongrong Miao11Shanxi Key Laboratory of Brain Disease Control, Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan, ChinaDepartment of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaChina National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Neurology, Radiology, Boston Medical Center, Boston, MA, United StatesDepartment of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaBackgroundThe incidence of acute ischemic stroke caused by large vessel occlusion is relatively infrequent in the young adult population. We sought to evaluate their clinical outcomes after endovascular treatment (EVT) and stroke etiology compared with older patients.MethodsWe examined data from the ANGEL-ACT registry, a nationwide study in China focusing on EVT for acute ischemic stroke. We compared two age groups: <50 years old and ≥50 years old. Our analysis focused on outcome measures such as the 90-day modified Rankin Scale (mRS) score, mortality, and symptomatic intracranial hemorrhage (sICH). We adjusted for confounding variables.ResultsWe included 1,691 patients, and 216 patients (13%) were <50 years old. Young patients had lower median National Institutes of Health Stroke Scale (NIHSS) scores (14 vs. 17, P < 0.001) and fewer cardiovascular comorbidities than older patients. Underlying intracranial atherosclerosis disease (ICAD) was higher in young patients (39.4 vs. 28.7%, P = 0.001). Clinical outcome was less favorable in older compared to younger patients (mRS shift: 0.76 [95% confidence interval (CI), 0.58–0.99]); functional independence [mRS score 0–2] 61% vs. 39% (adjusted odds ratio (OR), 0.7 [95% CI, 0.51–0.97]). Mortality and sICH did not differ between groups. Onset to puncture time (OTP) was longer in young patients (357 min vs. 294 min, P = 0.001).ConclusionAn estimated 13% of patients who underwent endovascular thrombectomy for acute ischemic stroke were <50 years old. Symptomatic underlying ICAD was more prevalent in the younger patient population. Despite a prehospital delay, younger patients exhibited more favorable outcomes than their older counterparts.https://www.frontiersin.org/articles/10.3389/fneur.2023.1255043/fullthrombectomyendovascular treatmentlarge vessel occlusionacute ischemic strokeyoung patientsoutcomes |
| spellingShingle | Bin Han Raynald Dapeng Sun Xu Tong Baixue Jia Anxin Wang Anxin Wang Dapeng Mo Feng Gao Ning Ma Thanh N. Nguyen Zhongrong Miao Endovascular treatment for young patients with acute large vessel occlusion stroke in China: analysis of the ANGEL-ACT registry Frontiers in Neurology thrombectomy endovascular treatment large vessel occlusion acute ischemic stroke young patients outcomes |
| title | Endovascular treatment for young patients with acute large vessel occlusion stroke in China: analysis of the ANGEL-ACT registry |
| title_full | Endovascular treatment for young patients with acute large vessel occlusion stroke in China: analysis of the ANGEL-ACT registry |
| title_fullStr | Endovascular treatment for young patients with acute large vessel occlusion stroke in China: analysis of the ANGEL-ACT registry |
| title_full_unstemmed | Endovascular treatment for young patients with acute large vessel occlusion stroke in China: analysis of the ANGEL-ACT registry |
| title_short | Endovascular treatment for young patients with acute large vessel occlusion stroke in China: analysis of the ANGEL-ACT registry |
| title_sort | endovascular treatment for young patients with acute large vessel occlusion stroke in china analysis of the angel act registry |
| topic | thrombectomy endovascular treatment large vessel occlusion acute ischemic stroke young patients outcomes |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1255043/full |
| work_keys_str_mv | AT binhan endovasculartreatmentforyoungpatientswithacutelargevesselocclusionstrokeinchinaanalysisoftheangelactregistry AT raynald endovasculartreatmentforyoungpatientswithacutelargevesselocclusionstrokeinchinaanalysisoftheangelactregistry AT dapengsun endovasculartreatmentforyoungpatientswithacutelargevesselocclusionstrokeinchinaanalysisoftheangelactregistry AT xutong endovasculartreatmentforyoungpatientswithacutelargevesselocclusionstrokeinchinaanalysisoftheangelactregistry AT baixuejia endovasculartreatmentforyoungpatientswithacutelargevesselocclusionstrokeinchinaanalysisoftheangelactregistry AT anxinwang endovasculartreatmentforyoungpatientswithacutelargevesselocclusionstrokeinchinaanalysisoftheangelactregistry AT anxinwang endovasculartreatmentforyoungpatientswithacutelargevesselocclusionstrokeinchinaanalysisoftheangelactregistry AT dapengmo endovasculartreatmentforyoungpatientswithacutelargevesselocclusionstrokeinchinaanalysisoftheangelactregistry AT fenggao endovasculartreatmentforyoungpatientswithacutelargevesselocclusionstrokeinchinaanalysisoftheangelactregistry AT ningma endovasculartreatmentforyoungpatientswithacutelargevesselocclusionstrokeinchinaanalysisoftheangelactregistry AT thanhnnguyen endovasculartreatmentforyoungpatientswithacutelargevesselocclusionstrokeinchinaanalysisoftheangelactregistry AT zhongrongmiao endovasculartreatmentforyoungpatientswithacutelargevesselocclusionstrokeinchinaanalysisoftheangelactregistry |