Occurrence of intracranial large vessel occlusion in consecutive, non-referred patients with acute ischemic stroke

Debbie Beumer,Diederik W J Dippel,Wim H Van Zwam,Robert J Van Oostenbrugge,Aad Van Der Lugt,Philip J Homburg,Maxim J H L Mulder,Ghesrouw Saiedie,Susanne Fonville

doi:10.1186/s40809-016-0022-5

Debbie Beumer, Diederik W J Dippel + Show 7 more

Open Access

https://doi.org/10.1186/s40809-016-0022-5

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Journal: Neurovascular Imaging	Publication Date: Sep 5, 2016
Citations: 32	License type: cc-by

Affiliation: Erasmus MC, Maastricht University

Abstract

The relative frequency of acute intracranial large vessel occlusion (LVO) in patients with acute ischemic stroke (AIS) who could be candidate for intra-arterial treatment (IAT) is not well known. In this study, we determined clinical variables associated with LVO and the proportion of patients with LVO among patients presenting with AIS within 6 h of symptom onset. Data of consecutive patients with AIS presenting at the emergency department (ED) of the Erasmus University Medical Center, in the Netherlands, was used. Referrals from other hospitals were excluded. From 2006 January 1st to 2012 April 30th, 1063 non-referred patients presented at our ED with AIS. 445 (42 %) arrived within 6 h of onset of symptoms. Computed tomography angiography was not performed or was of insufficient quality in 50 patients (11 %) and performed late (≥1 day) in 57 patients (13 %). The remaining 338 with AIS were included in the final analysis. 106 patients (31 %) had LVO, mostly in the anterior circulation (72 %). National Institutes of Health Stroke Scale score was the only variable associated with the presence of LVO (adjusted OR 1.23 per point [95 % Confidence interval: 1.17–1.29]). Of all patients with acute ischemic stroke who arrive within 6 h of symptom onset at the emergency department, almost one out of three have a intracranial large vessel occlusion and may be candidate for intra-arterial treatment.

Highlights

The relative frequency of acute intracranial large vessel occlusion (LVO) in patients with acute ischemic stroke (AIS) who could be candidate for intra-arterial treatment (IAT) is not well known
Recently published randomized clinical trials showed that intra-arterial treatment (IAT) with retrievable stents for acute ischemic stroke (AIS) was safe and effective in patients with acute intracranial large vessel occlusion (LVO) if they were treated within 6 h of symptom onset [1,2,3,4,5,6]
Patients who did not receive a Computed Tomography Angiography (CTA) or in whom the CTA was of insufficient quality, and patients in whom a CTA was made more than 24 h after intravenous alteplase treatment (IVT) or more than 48 h after stroke onset were excluded from the present study

Summary

Introduction

The relative frequency of acute intracranial large vessel occlusion (LVO) in patients with acute ischemic stroke (AIS) who could be candidate for intra-arterial treatment (IAT) is not well known. Published randomized clinical trials showed that intra-arterial treatment (IAT) with retrievable stents for acute ischemic stroke (AIS) was safe and effective in patients with acute intracranial large vessel occlusion (LVO) if they were treated within 6 h of symptom onset [1,2,3,4,5,6]. Updated guidelines indicate that IAT is standard of care for AIS patients with LVO [7, 8] This has great impact on stroke care providers, as the number of performed procedures increases rapidly and resources are limited. Observational studies report that 10–61 % of the patients who present at the emergency department (ED) with presumed AIS have LVO. These studies did not include unselected, consecutive patients [9], did not use appropriate neuro-imaging in all patients [10], included patients who were transferred from other hospitals [11, 12], or used a restricted time window [13]

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