Emerging Detection Techniques for Large Vessel Occlusion Stroke: A Scoping Review.

Jennifer K Nicholls,Emma M L Chung,Jonathan Ince,Jatinder S Minhas

doi:10.3389/fneur.2021.780324

Abstract

Background: Large vessel occlusion (LVO) is the obstruction of large, proximal cerebral arteries and can account for up to 46% of acute ischaemic stroke (AIS) when both the A2 and P2 segments are included (from the anterior and posterior cerebral arteries). It is of paramount importance that LVO is promptly recognised to provide timely and effective acute stroke management. This review aims to scope recent literature to identify new emerging detection techniques for LVO. As a good comparator throughout this review, the commonly used National Institutes of Health Stroke Scale (NIHSS), at a cut-off of ≥11, has been reported to have a sensitivity of 86% and a specificity of 60% for LVO.Methods: Four electronic databases (Medline via OVID, CINAHL, Scopus, and Web of Science), and grey literature using OpenGrey, were systematically searched for published literature investigating developments in detection methods for LVO, reported from 2015 to 2021. The protocol for the search was published with the Open Science Framework (10.17605/OSF.IO/A98KN). Two independent researchers screened the titles, abstracts, and full texts of the articles, assessing their eligibility for inclusion.Results: The search identified 5,082 articles, in which 2,265 articles were screened to assess their eligibility. Sixty-two studies remained following full-text screening. LVO detection techniques were categorised into 5 groups: stroke scales (n = 30), imaging and physiological methods (n = 15), algorithmic and machine learning approaches (n = 9), physical symptoms (n = 5), and biomarkers (n = 3).Conclusions: This scoping review has explored literature on novel and advancements in pre-existing detection methods for LVO. The results of this review highlight LVO detection techniques, such as stroke scales and biomarkers, with good sensitivity and specificity performance, whilst also showing advancements to support existing LVO confirmatory methods, such as neuroimaging.

Highlights

Large vessel occlusion (LVO) is the obstruction of large, proximal cerebral arteries and accounts for 24–46% of acute ischaemic stroke (AIS), when including both A2 and P2 segments of the anterior and posterior cerebral arteries [1]
To improve patient outcomes and to minimise the time to reperfusion, early detection and direct transportation to a comprehensive stroke centre (CSC) via the mothership pathway should be considered. This was highlighted in recent American Heart Association (AHA) Guidelines (2019), which called for research in identifying effective pre-hospital procedures for triaging patients to the most appropriate centres, including operational bypass algorithms [5]
80 did not meet the inclusion criteria for various reasons, including studies that could only be retrieved in abstract form (n = 10), records using secondary research (n = 17), research exploring well-established diagnostic techniques in a non-novel way (n = 35), and studies that were irrelevant to the research question (n = 18)

Summary

Introduction

Large vessel occlusion (LVO) is the obstruction of large, proximal cerebral arteries and accounts for 24–46% of acute ischaemic stroke (AIS), when including both A2 and P2 segments of the anterior and posterior cerebral arteries [1]. An alternative pathway to the mothership is the “drip and ship” pathway, known as the primary care pathway—here, patients are sent to the nearest stroke centre that provides intravenous thrombolysis (IVT) as early as possible. To improve patient outcomes and to minimise the time to reperfusion, early detection and direct transportation to a CSC via the mothership pathway should be considered. This was highlighted in recent American Heart Association (AHA) Guidelines (2019), which called for research in identifying effective pre-hospital procedures for triaging patients to the most appropriate centres, including operational bypass algorithms [5]. As a good comparator throughout this review, the commonly used National Institutes of Health Stroke Scale (NIHSS), at a cut-off of ≥11, has been reported to have a sensitivity of 86% and a specificity of 60% for LVO

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