Objective To investigate the the etiology of young adults with acute large vessel occlusion stroke (ALVOS) and its safety and effectiveness of endovascular treatment.

Methods From January 2018 to December 2021, clinical data of 40 young patients with ALVOS were retrospectively analyzed. The etiology of young patients with ALVOS, the success rate and occurrence of complications of endovascular treatment were analyzed. The neurological function of the patients at admission and at discharge was evaluated using the National Institutes of Health Stroke Scale (NIHSS) score. According to the modified Rankin scale (mRS) score at 90 days after surgery, the patients were divided into good prognosis patients (mRS scored≤2) and poor prognosis patients (mRS scored>2). Clinical data of the patients with good prognosis and poor prognosis and the NIHSS score at baseline and at discharge were compared.

Results A total of 40 patients were enrolled in this study. There were thirty-two males(80.0%) and eight females (20.0%). The age was 41.5(36.0, 44.0) years. According to Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, there were 18 cases(45.0%) of large atherosclerotic type (LAA), 12 cases (30.0%) of cardiac embolism(CE) type, 8 cases (20.0%) of other causes (SOE) and 2 cases (5.0%) of unexplained causes(SUE) type. Thirty-eight patients resulted in successfully recanalization, and two patients failed, without serious complications. Six patients had symptomatic intracranial hemorrhage after operation. The NIHSS score at discharge was 2.0(0.3, 7.5), which was lower than 12.0(6.3, 15.8) at baseline (P < 0.05). At 90 days of follow-up, 29 patients achieved good outcome(mRS score 0 to 2), five patients died (mRS score 6). There were significant differences in the body mass index (BMI), operation time, times of thrombectomy and symptomatic intracranial hemorrhage between the good prognosis patients and the poor prognosis patients(P < 0.05).

Conclusion LAA type and carotid artery dissection are common causes of ALVOS in young adults. Endovascular treatment of ALVOS caused by various etiologies in young patients is safe and effective. BMI, operation time, times of thrombectomy, and symptomatic intracranial hemorrhage may affect the prognosis of endovascular treatment in young ALVOS patients.