To determine if younger, compared to older, patients have differences in quality of life (QoL) after large vessel occlusion (LVO) stroke treated with endovascular thrombectomy (EVT) in the extended window (6-16 hours from last normal).  

The QoL effects of LVO stroke on younger versus older patients has not been adequately explored.

We included patients randomized to EVT in DEFUSE 3. We divided the cohort into younger (≤60 years) versus older (>60). The primary outcome was a 32-question neurological QoL scale (n-QoL), measured at 90 days from stroke. We allocated the n-QoL into 8-questions domains: functional, psychological, social/activity, and cognitive. Higher scores reflect better QoL in the functional, social/activity, and cognitive domains, but lower QoL in the psychological domain. We tested differences in the mean QoL score by Student’s t-test and fit linear regression models to the domains’ QoL score, adjusted for sex, race/ethnicity, tPA administration, TOAST category, ischemic core volume, and post-procedural TICI score.

We included 72 patients, of which 23 (31.9%) were ≤60 and 49 (68.1%) were >60. The mean QoL score by domain for younger versus older patients was: functional=4.0 vs. 3.5 (p=0.116), psychologic=1.3 vs. 1.8 (p=0.013), social/activity=3.8 vs. 3.2 (p=0.151) and cognitive=4.1 vs. 3.6 (p=0.073). In the adjusted regression models, younger age was associated with better social/activity (β coefficient=0.83, p=0.047) and psychological (β coefficient= -0.55, p=0.020) domain scores, but not cognitive or functional domain scores. The proportion of younger versus older patients with good outcome (modified Rankin Scale 0-2) was not significantly different (chi-squared test, p=0.147), nor was the ordinal mRS (Mann-Whitney U test, p=0.153).

Although these findings are preliminary, our analysis suggests younger LVO stroke patients treated with EVT in the extended window have better psychological and social/activity QoL outcomes compared to older patients. This underappreciated impact of LVO stroke on older patients warrants additional research.