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Acute Ischemic Stroke with Vessel Occlusion-Prevalence and Thrombectomy Eligibility at a Comprehensive Stroke Center.
J Stroke Cerebrovasc Dis. 2019 Nov; 28(11):104315.JS

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.

Authors+Show Affiliations

Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.Cooper Neurological Institute, Cooper University Medical Center, Camden, New Jersey.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.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31409537

Citation

Desai, Shashvat M., et al. "Acute Ischemic Stroke With Vessel Occlusion-Prevalence and Thrombectomy Eligibility at a Comprehensive Stroke Center." Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association, vol. 28, no. 11, 2019, p. 104315.
Desai SM, Starr M, Molyneaux BJ, et al. Acute Ischemic Stroke with Vessel Occlusion-Prevalence and Thrombectomy Eligibility at a Comprehensive Stroke Center. J Stroke Cerebrovasc Dis. 2019;28(11):104315.
Desai, S. M., Starr, M., Molyneaux, B. J., Rocha, M., Jovin, T. G., & Jadhav, A. P. (2019). Acute Ischemic Stroke with Vessel Occlusion-Prevalence and Thrombectomy Eligibility at a Comprehensive Stroke Center. Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association, 28(11), 104315. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104315
Desai SM, et al. Acute Ischemic Stroke With Vessel Occlusion-Prevalence and Thrombectomy Eligibility at a Comprehensive Stroke Center. J Stroke Cerebrovasc Dis. 2019;28(11):104315. PubMed PMID: 31409537.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute Ischemic Stroke with Vessel Occlusion-Prevalence and Thrombectomy Eligibility at a Comprehensive Stroke Center. AU - Desai,Shashvat M, AU - Starr,Matthew, AU - Molyneaux,Bradley J, AU - Rocha,Marcelo, AU - Jovin,Tudor G, AU - Jadhav,Ashutosh P, Y1 - 2019/08/10/ PY - 2019/06/10/received PY - 2019/07/19/accepted PY - 2019/8/15/pubmed PY - 2019/12/24/medline PY - 2019/8/15/entrez KW - Stroke—ischemic stroke—epidemiology—thrombectomy—guideline—eligibility—neurointervention SP - 104315 EP - 104315 JF - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association JO - J Stroke Cerebrovasc Dis VL - 28 IS - 11 N2 - 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. SN - 1532-8511 UR - https://www.unboundmedicine.com/medline/citation/31409537/Acute_Ischemic_Stroke_with_Vessel_Occlusion_Prevalence_and_Thrombectomy_Eligibility_at_a_Comprehensive_Stroke_Center_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1052-3057(19)30356-8 DB - PRIME DP - Unbound Medicine ER -