Shashvat M Desai1, Matthew Starr1, Bradley J Molyneaux1, Marcelo Rocha1, Tudor G Jovin2, Ashutosh P Jadhav3. 1. Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 2. Cooper Neurological Institute, Cooper University Medical Center, Camden, New Jersey. 3. Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Electronic address: jadhavap@upmc.edu.
Abstract
INTRODUCTION: Endovascular thrombectomy (ET) for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO) can prevent severe disability and mortality. There is currently limited data on the epidemiology of LVO strokes and ET eligibility. We aim to determine the incidence of intracranial vessel occlusion (IVO) strokes eligible for ET per 2018 American Heart Association (AHA) guidelines and characteristics of an AHA ineligible population at a comprehensive stroke center (CSC). METHODS: Retrospective chart review of all consecutive AISs at a CSC between November 2014 and February 2017. Demographic, clinical, and radiographic data were analyzed to determine ET eligibility per AHA guidelines and characteristics of ineligible patients were investigated. RESULTS: Twenty-four percent of AIS harbor an IVO. Thirty percent of IVO strokes and 47% of anterior circulation LVO strokes are thrombectomy eligible per AHA guidelines. Most common reasons for thrombectomy ineligibility among IVO strokes are presence of IVO other than anterior circulation LVO (35%, n = 224), presence of large stroke burden (15%, n = 93), baseline modified Rankin scale greater than or equal to 2 (14%, n = 89), and NIHSS score less than 6 (15%, n = 96). CONCLUSIONS: At a CSC, 1 in 4 AISs harbor an IVO. Seven in 100 acute ischemic strokes, 3 in 10 strokes with vessel occlusion, and 1 in 2 strokes with internal carotid or middle cerebral artery M1 occlusion are thrombectomy eligible per AHA 2018 guidelines. These data highlight that current guidelines render a majority of strokes thrombectomy ineligible and a large window of opportunity exists for clinical investigation.
INTRODUCTION: Endovascular thrombectomy (ET) for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO) can prevent severe disability and mortality. There is currently limited data on the epidemiology of LVO strokes and ET eligibility. We aim to determine the incidence of intracranial vessel occlusion (IVO) strokes eligible for ET per 2018 American Heart Association (AHA) guidelines and characteristics of an AHA ineligible population at a comprehensive stroke center (CSC). METHODS: Retrospective chart review of all consecutive AISs at a CSC between November 2014 and February 2017. Demographic, clinical, and radiographic data were analyzed to determine ET eligibility per AHA guidelines and characteristics of ineligible patients were investigated. RESULTS: Twenty-four percent of AIS harbor an IVO. Thirty percent of IVO strokes and 47% of anterior circulation LVO strokes are thrombectomy eligible per AHA guidelines. Most common reasons for thrombectomy ineligibility among IVO strokes are presence of IVO other than anterior circulation LVO (35%, n = 224), presence of large stroke burden (15%, n = 93), baseline modified Rankin scale greater than or equal to 2 (14%, n = 89), and NIHSS score less than 6 (15%, n = 96). CONCLUSIONS: At a CSC, 1 in 4 AISs harbor an IVO. Seven in 100 acute ischemic strokes, 3 in 10 strokes with vessel occlusion, and 1 in 2 strokes with internal carotid or middle cerebral artery M1 occlusion are thrombectomy eligible per AHA 2018 guidelines. These data highlight that current guidelines render a majority of strokes thrombectomy ineligible and a large window of opportunity exists for clinical investigation.
Authors: Emily W Avery; Jonas Behland; Adrian Mak; Stefan P Haider; Tal Zeevi; Pina C Sanelli; Christopher G Filippi; Ajay Malhotra; Charles C Matouk; Christoph J Griessenauer; Ramin Zand; Philipp Hendrix; Vida Abedi; Guido J Falcone; Nils Petersen; Lauren H Sansing; Kevin N Sheth; Seyedmehdi Payabvash Journal: Neuroimage Clin Date: 2022-05-07 Impact factor: 4.891
Authors: Paul Reidler; Lena Stueckelschweiger; Daniel Puhr-Westerheide; Katharina Feil; Lars Kellert; Konstantinos Dimitriadis; Steffen Tiedt; Moriz Herzberg; Jan Rémi; Thomas Liebig; Matthias P Fabritius; Wolfgang G Kunz Journal: Clin Neuroradiol Date: 2020-09-16 Impact factor: 3.649