Neurol Res. 2025 Sep 4:1-10. doi: 10.1080/01616412.2025.2549034. Online ahead of print.
ABSTRACT
BACKGROUND AND PURPOSE: Data on endovascular thrombectomy (EVT) for acute vertebrobasilar artery occlusion (VBAO) in young adults are limited. We compared clinical characteristics and outcomes after EVT between young and older patients.
METHODS: Using a multicenter retrospective registry, we analyzed patients undergoing EVT for acute VBAO. Patients were dichotomized by age (18-44 years vs ≥ 45 years). Primary outcomes were functional independence (modified Rankin Scale score, mRS 0-2) at 90 days and 1 year. Secondary outcomes included successful reperfusion, 24-hour/discharge National Institute of Health Stroke Scale (NIHSS) scores, early neurological function changes, 90-day/1-year mRS distributions, symptomatic intracranial hemorrhage (sICH), and mortality. Multivariable logistic regression adjusted for confounders assessed associations. Interaction effects between age group and hypertension/diabetes/atrial fibrillation were evaluated.
RESULTS: Among 518 patients, 37 (7.1%) were aged 18-44 years. Young patients had fewer cardiovascular comorbidities. Etiologies were more heterogeneous in young patients (large-artery atherosclerosis: 35.1%, other determined cause: 35.1%). Young patients more frequently achieved early neurological improvement and functional independence at 90 days and 1 year (unadjusted). Adjusted analyses showed age dichotomization was not significantly associated with 90-day (aOR 1.15, 95% CI 0.50-2.64, p = 0.74) or 1-year (aOR 1.59, 95% CI 0.68-3.72, p = 0.286) functional independence. A significant hypertension-by-age interaction existed for 90-day functional independence (p = 0.014), and no significant interactions were found for other comorbidities or at 1 year. Mortality and sICH rates were comparable between the two groups.
CONCLUSIONS: EVT demonstrates comparable efficacy in young and older VBAO patients, underscoring its critical value especially for young patients with more heterogeneous etiologies.
PMID:40905244 | DOI:10.1080/01616412.2025.2549034