Prognostic significance of age within the adolescent and young adult acute ischemic stroke population after mechanical thrombectomy: insights from STAR

Victor M. LuDepartment of Neurosurgery, University of Miami, Miami, Florida;

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Evan M. LutherDepartment of Neurosurgery, University of Miami, Miami, Florida;

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Michael A. SilvaDepartment of Neurosurgery, University of Miami, Miami, Florida;

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Turki ElarjaniDepartment of Neurosurgery, University of Miami, Miami, Florida;

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Ahmed AbdelsalamDepartment of Neurosurgery, University of Miami, Miami, Florida;

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Ilko MaierDepartment of Neurology, University Medical Center Gottingen, Gottingen, Germany;

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Sami Al KasabDepartment of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina;

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Pascal M. JabbourDepartment of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania;

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Joon-Tae KimDepartment of Neurosurgery, Chonnam National University Hospital, Gwangju, South Korea;

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Stacey Q. WolfeDepartment of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina;

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Ansaar T. RaiDepartment of Neuroradiology, University of West Virginia, Morgantown, West Virginia;

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Marios-Nikos PsychogiosDepartment of Radiology, University Hospital Basel, Basel, Switzerland;

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Edgar A. SamaniegoDepartment of Neurosurgery, University of Iowa, Iowa City, Iowa;

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Adam S. ArthurDepartment of Neurosurgery, Semmes Murphey Neurologic and Spine Clinic, Memphis, Tennessee;

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Shinichi YoshimuraDepartment of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan;

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Jonathan A. GrossbergDepartment of Neurosurgery, Emory University, Atlanta, Georgia;

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Ali AlawiehDepartment of Neurosurgery, Emory University, Atlanta, Georgia;

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Isabel FragataDepartment of Neuroradiology, Hospital Sao Jose Centro Hospitalar Lisboa Central, Lisboa, Portugal;

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Adam PolifkaDepartment of Neurosurgery, University of Florida, Gainesville, Florida;

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Justin MascitelliDepartment of Neurosurgery, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas;

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Joshua OsbunDepartment of Neurosurgery, Washington University in St. Louis, St. Louis, Missouri;

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Min S. ParkDepartment of Neurosurgery, University of Virginia, Charlottesville, Virginia;

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Michael R. LevittDepartment of Neurosurgery, University of Washington, Seattle, Washington;

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Travis DumontDepartment of Neurosurgery, University of Arizona, Tucson, Arizona;

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Hugo CuellarDepartment of Radiology, Louisiana State University Health Shreveport, Shreveport, Louisiana;

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Richard W. Williamson Jr.Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania;

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Daniele G. RomanoDepartment of Neuroradiology, University Hospital San Giovanni di Dio e Ruggi d’Aragona, University of Salerno, Salerna, Italy;

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Roberto CrosaDepartment of Neurosurgery, Neurological Endovascular Center, Medica Uruguaya, Montevideo, Uruguay;

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Benjamin GoryDepartment of Interventional Neuroradiology, Centre Hospitalier Universitaire de Nancy, Nancy, France;

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Maxim MokinDepartment of Neurosurgery, University of South Florida, Tampa, Florida;

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Mark MossDepartment of Interventional Neuroradiology, Washington Regional Medical, Fayetteville, Arkansas;

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Kaustubh LimayeDepartment of Interventional Neuroradiology, Indiana University, Indianapolis, Indiana; and

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Peter KanDepartment of Neurosurgery, University of Texas Medical Branch—Galveston, Galveston, Texas

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Dileep R. YavagalDepartment of Neurosurgery, University of Miami, Miami, Florida;

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Alejandro M. SpiottaDepartment of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina;

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Robert M. StarkeDepartment of Neurosurgery, University of Miami, Miami, Florida;

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OBJECTIVE

Although younger adults have been shown to have better functional outcomes after mechanical thrombectomy (MT) for acute ischemic stroke (AIS), the significance of this relationship in the adolescent and young adult (AYA) population is not well defined given its undefined rarity. Correspondingly, the goal of this study was to determine the prognostic significance of age in this specific demographic following MT for large-vessel occlusions.

METHODS

A prospectively maintained international multi-institutional database, STAR (Stroke Thrombectomy and Aneurysm Registry), was reviewed for all patients aged 12–18 (adolescent) and 19–25 (young adult) years. Parameters were compared using chi-square and t-test analyses, and associations were interrogated using regression analyses.

RESULTS

Of 7192 patients in the registry, 41 (0.6%) satisfied all criteria, with a mean age of 19.7 ± 3.3 years. The majority were male (59%) and young adults (61%) versus adolescents (39%). The median prestroke modified Rankin Scale (mRS) score was 0 (range 0–2). Strokes were most common in the anterior circulation (88%), with the middle cerebral artery being the most common vessel (59%). The mean onset-to–groin puncture and groin puncture–to-reperfusion times were 327 ± 229 and 52 ± 42 minutes, respectively. The mean number of passes was 2.2 ± 1.2, with 61% of the cohort achieving successful reperfusion. There were only 3 (7%) cases of reocclusion. The median mRS score at 90 days was 2 (range 0–6). Between the adolescent and young adult subgroups, the median mRS score at last follow-up was statistically lower in the adolescent subgroup (1 vs 2, p = 0.03), and older age was significantly associated with a higher mRS at 90 days (coefficient 0.33, p < 0.01).

CONCLUSIONS

Although rare, MT for AIS in the AYA demographic is both safe and effective. Even within this relatively young demographic, age remains significantly associated with improved functional outcomes. The implication of age-dependent stroke outcomes after MT within the AYA demographic needs greater validation to develop effective age-specific protocols for long-term care across both pediatric and adult centers.

ABBREVIATIONS

ADAPT = A Direct Aspiration First Pass Technique; AIS = acute ischemic stroke; AYA = adolescent and young adult; LVO = large-vessel occlusion; mRS = modified Rankin Scale; MT = mechanical thrombectomy; STAR = Stroke Thrombectomy and Aneurysm Registry; TICI = Thrombolysis in Cerebral Infarction.
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Image from Tran et al. (pp 394–399).

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