Ischemic stroke in working ages : large vessel occlusion, work capacity and outcome after thrombectomy

This thesis examines outcomes of ischemic stroke patients of working age. Stroke patients of working age risk permanent or long-term disability, which in turn affects many aspects of their individual lives.

Large vessel occlusions are a cause of severe stroke, however, the prevalence is widely varying depending on the method and definition. We determined the prevalence in a Swedish untriaged setting (Study I). We found a lower prevalence than previously described, 11.3% of all ischemic stroke events. The reason could be related to clinical practice regarding detection at the time, as computer tomography angiography was not performed in half of the patients. Patients of working ages did not have more large vessel occlusions compared to older patients.

Patients with large vessel occlusions are eligible for thrombectomy treatment. Mechanical thrombectomy is the technique of retrieving the thrombus through manual extraction. The histological components of the extracted thrombi were analyzed in Study II. We found that pharmaceutical therapies such as anticoagulants alter the thrombus composition, however antiplatelet therapy did not. There was no age-related difference in thrombus composition.

The outcomes after thrombectomy treatment have been very encouraging, however, due to limited statistical power it remains unclear whether thrombectomy is beneficial in ages below 50. Study III investigated the nationwide outcomes of working-aged patients. We found that the outcome of working-aged patients was better, and the risk of subsequent brain hemorrhage and mortality was lower compared to older patients.

The ability to work is often regarded as one of the most important matters for stroke patients in rehabilitation. We performed a nationwide study on sickness absence and disability pension on stroke patients of working ages (Study IV). Over time, stroke patients demonstrate lowered rates of sickness absence and disability pension. Still, in the year before stroke onset, stroke patients showed elevated absence rates compared to matched references with similar socioeconomic backgrounds. These absence days were mostly related to mental and musculoskeletal disorders.

Patients treated with thrombectomy risk severe stroke outcomes. For these patients, work-related outcomes are underexamined. Study V investigates the sickness absence and disability pension of all treated patients, showing that one third of patients are not sickness absent at 30 days after treatment, with increasing rates at follow-up. These results supplement traditional stroke outcomes such as functional independence after stroke.

List of scientific papers

I. Prevalence of large vessel occlusions in an unselected hospital- based stroke cohort in Sweden. Roland M, Markaki I, Arnberg F, Klironomos S, Sjöstrand C. Frontiers in Neurology. (2025). https://doi.org/10.3389/fneur.2025.1549537

II. Anticoagulants and other predictors of thrombus composition in patients treated with thrombectomy. Roland M, Aspegren O, Sjöstrand C, Arnberg F. [Manuscript]

III. Mechanical thrombectomy in stroke patients of working age: Real-world outcomes in Sweden. Roland M, Markaki I, Andersson T, Arnberg F, Sjöstrand C. European Stroke Journal. (2022). https://doi.org/10.1177/23969873211067883

IV. Sickness absence and disability pension before and after ischemic stroke: a Swedish longitudinal cohort study with matched references. Roland M, Rudberg AS, Alexanderson K, Sjöstrand C. European Stroke Journal. (2024). https://doi.org/10.1177/23969873241261011

V. Sickness absence and disability pension in stroke patients treated with mechanical thrombectomy. Roland M, Rudberg AS, Arnberg F, Alexanderson K, Sjöstrand C. Journal of Stroke and Cerebrovascular Diseases. (2025). https://doi.org/10.1016/j.jstrokecerebrovasdis.2025.108236