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    Home > Active Ingredient News > Study of Nervous System > Stroke: What are the clinical characteristics of young stroke?

    Stroke: What are the clinical characteristics of young stroke?

    • Last Update: 2021-12-26
    • Source: Internet
    • Author: User
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    Endovascular therapy (EVT) is the standard treatment for patients with acute ischemic stroke in the anterior circulation caused by intracranial occlusion (LVO)
    .
    As with general strokes, most patients receiving EVT are older

    .
    In a high-efficiency reperfusion collaborative meta-analysis evaluated in multiple intravascular stroke trials, the median age of patients was 68 years

    .

    Vascular Stroke

    In studies that reflect daily clinical routines, the median age is even higher, varying between 713 and 75 years old
    .
    Stroke caused by LVO is not common in young patients (<50 years old).

    Therefore, data on the outcome and underlying causes of these patients after EVT are limited
    .
    In a high-efficiency reperfusion collaborative meta-analysis evaluated in multiple intravascular stroke trials, 56% of 18 to 49-year-old patients in the intervention group had good results, compared with only 47% in the control group

    .

    The direction of the effect seems to favor EVT, although no statistical significance (adjusted odds together to 1.
    36 [95% CI, 0.
    75-2.
    46])

    .
    There is very little literature that specifically studies EVT in young patients, and little is known about the outcome of these patients and the cause of stroke

    .
    Most studies on strokes caused by LVO in young patients have small sample sizes, are single-centered, or have not paid special attention to EVT

    .

    statistics

    In this way, Josje Brouwer and others of the University of Amsterdam explored the causes of stroke in young LVO stroke patients receiving EVT treatment at a large national Dutch stroke registration center
    .
    In addition, the clinical and radiological results after EVT in young and elderly patients were compared

    .

    Method
    .
    We used data from patients with anterior circulation great vessel occlusion stroke (March 2014 to November 2017).
    These data come from the MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands) registry.
    It is a
    national prospective study on intravascular
    thrombectomy in the Netherlands
    .
    We compared young patients (18-49 years old) and elderly patients (≥50 years old)

    .
    The results included a modified Rankin scale score (displacement and dichotomy analysis) after 90 days, an expanded thrombolytic score for cerebral infarction, and symptomatic intracranial hemorrhage

    .
    The analysis adjusted for confounding factors

    .

    thrombus

    They enrolled 3256 patients, 310 (10%) were 18 to 49 years old
    .
    Compared with older patients, younger patients had a lower median score on the National Institutes of Health Stroke Scale (14 points vs.
    16 points, P<0.
    001), and fewer cardiovascular disease complications

    .
    The causes of stroke in young patients include carotid dissection (16%), cardiac embolism (15%), aortic atherosclerosis (10%), and embolic stroke of unknown origin (31%)

    .

    The clinical outcome of young patients is better than that of elderly patients (acOR of the modified Rankin scale conversion: 1.
    8 [95% CI, 1.
    5-2.
    2]; functional independence [modified Rankin scale score 0-2] 61 versus 39% [after adjustment The odds ratio is 2.
    1[95%CI, 1.
    6-2.
    8]]; the mortality rate is 7% to 32%, and the adjusted odds ratio is 0.
    2[95%CI, 0.
    1-0.
    3])

    .

    The incidence of symptomatic intracranial hemorrhage is lower in young patients (3% vs.
    6%, adjusted odds ratio, 0.
    5[95%CI, 0.
    2-1.
    00])

    .

    Successful reperfusion (Expanded Cerebral Infarction Thrombolysis Score 2b-3) did not differ between the groups
    .
    The time from onset to reperfusion is shorter in young patients

    .


    The important significance of this study is that it found that 10% of acute ischemic stroke patients undergoing endovascular thrombectomy are younger than 50 years old
    .
    Cardiac embolism and carotid artery dissection are common basic causes in young patients

    .
    One-third of the cases did not find the cause, indicating that more research is needed on the causes of stroke in young patients

    .
    Compared with elderly patients, younger patients have a better prognosis and a lower risk of symptomatic intracranial hemorrhage

    .


    10% of acute ischemic stroke patients undergoing endovascular thrombectomy are younger than 50 years old
    .
    Cardiac embolism and carotid artery dissection are common basic causes in young patients

     

    Original source:
    Brouwer J, Smaal JA, Emmer BJ, et al.
    Endovascular Thrombectomy in Young Patients With Stroke: A MR CLEAN Registry Study .
    Stroke.
    Published online December 7, 2021:STROKEAHA.
    120.
    034033.
    doi:10.
    1161/STROKEAHA.
    120.
    034033


    Endovascular Thrombectomy in Young Patients With Stroke: A MR CLEAN Registry Study

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