Background An accurate estimate of large vessel occlusion (LVO) incidence is critical for planning stroke systems of care and approximating workforce requirements. The purpose of this systematic review was to estimate LVO prevalence among acute ischemic stroke (AIS) patients with emphasis on definitions and methods used by different studies.
Methods Using Medical Subject Headings terms, EMBASE, PubMed, Web of Science, Google Scholar, and the Cochrane Library were searched for prevalence of LVO and AIS from 2000–2018. All articles in the English literature describing the frequency of LVO among AIS patients were included in this review. Studies without consecutive recruitment or without confirmation of LVO with computed tomography angiography or magnetic resonance angiography were excluded. Studies were grouped based on similarities in LVO definition and methods.
Results Eighteen records met the eligibility criteria. Five studies presented population-based estimates and 13 provided single-hospital experiences (5 prospective, 8 retrospective). The AIS denominator (number of all AIS) from which LVO rates were generated was variable. Nine different definitions were used, based on occlusion site. The prevalence of LVO among suspected AIS patients ranged from 13–46%. The overall prevalence was 29.1% (95% CI, 21.5–36.77). Pooled prevalence of LVO among suspected AIS patients in population-based studies was 27.10% (95% CI 19.46–34.74); for studies defining AIS based on magnetic resonance imaging, it was 21.49% (95% CI 13.8–29.1).
Conclusion LVO definition and AIS denominator greatly influence estimates of LVO prevalence among AIS patients. Population-based studies with standardized methods must be conducted to provide data for planning and developing stroke systems of care.
Disclosures M. Waqas: None. A. Rai: 2; C; Medtronic, Cerenovus. K. Vakharia: None. A. Siddiqui: 1; C; Co-investigator NIH/NINDS 1R01NS091075. 2; C; Amnis Therapeutics, Boston Scientific, Canon Medical Systems USA Inc, Cerebrotech Medical Systems, Cerenovus, Corindus Inc., Endostream Medical Ltd, Guidepoint Global Consulting, Imperative Care, Integra LifeSciences Corp, Medtronic, MicroVention, Q’Apel Medical Inc, Rapid Medical, Rebound Therapeutics Corp., Serenity Medical Inc, Silk Road Medical, StimMed, Stryker, Three Rivers Medical, VasSol, W.L. Gore & Associates. 4; C; Amnis Therapeutics, Apama Medical, Blink TBI Inc, Buffalo Technology Partners Inc, Cardinal Consultants, Cerebrotech Medical Systems, Cognition Medical, Endostream Medical Ltd, Imperative Care, International Medical Distribution Partners, Neurovascular Diagnostics Inc, Q’Apel Medical Inc, Rebound Therapeutics Corp, Rist Neurovascular In, Serenity Medical, Silk Road Medical, StimMed, Synchron, Three Rivers Medical Inc, Viseon Spine.
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