Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Nov 30:8:651.
doi: 10.3389/fneur.2017.00651. eCollection 2017.

Ischemic Strokes Due to Large-Vessel Occlusions Contribute Disproportionately to Stroke-Related Dependence and Death: A Review

Konark Malhotra  1 , Jeffrey Gornbein  2 , Jeffrey L Saver  3
Affiliations
Review

Ischemic Strokes Due to Large-Vessel Occlusions Contribute Disproportionately to Stroke-Related Dependence and Death: A Review

Konark Malhotra et al. Front Neurol. .

Abstract

Background: Since large-vessel occlusion (LVO)-related acute ischemic strokes (AIS) are associated with more severe deficits, we hypothesize that the endovascular thrombectomy (ET) may disproportionately benefit stroke-related dependence and death.

Methods: To delineate LVO-AIS impact, systematic search identified studies measuring dependence or death [modified Rankin Scale (mRS) 3-6] or mortality following ischemic stroke among consecutive patients presenting with both LVO and non-LVO events within 24 h of symptom onset.

Results: Among 197 articles reviewed, 2 met inclusion criteria, collectively enrolling 1,467 patients. Rates of dependence or death (mRS 3-6) within 3-6 months were higher after LVO than non-LVO ischemic stroke, 64 vs. 24%, odds ratio (OR) 4.46 (CI: 3.53-5.63, p < 0.0001). Mortality within 3-6 months was higher after LVO than non-LVO ischemic stroke, 26.2 vs. 1.3%, OR 4.09 (CI: 2.5-6.68), p < 0.0001. Consequently, while LVO ischemic events accounted for 38.7% (CI: 21.8-55.7%) of all acutely presenting ischemic strokes, they accounted for 61.6% (CI: 41.8-81.3%) of poststroke dependence or death and 95.6% (CI: 89.0-98.8%) of poststroke mortality. Using literature-based projections of LVO cerebral ischemia patients treatable within 8 h of onset, ET can be used in 21.4% of acutely presenting patients with ischemic stroke, and these events account for 34% of poststroke dependence and death and 52.8% of poststroke mortality.

Conclusion: LVOs cause a little more than one-third of acutely presenting AIS, but are responsible for three-fifths of dependency and more than nine-tenths of mortality after AIS. At the population level, ET has a disproportionate benefit in reducing severe stroke outcomes.

Keywords: endovascular; ischemic; morbidity; stroke; vessel occlusion.

PubMed Disclaimer

References

    1. Malhotra K, Liebeskind DS. Imaging in endovascular stroke trials. J Neuroimaging (2015) 25(4):517–27.10.1111/jon.12272 - DOI - PMC - PubMed
    1. Campbell BC, Donnan GA, Lees KR, Hacke W, Khatri P, Hill MD, et al. Endovascular stent thrombectomy: the new standard of care for large vessel ischaemic stroke. Lancet Neurol (2015) 14(8):846–54.10.1016/s1474-4422(15)00140-4 - DOI - PubMed
    1. Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet (2016) 387(10029):1723–31.10.1016/s0140-6736(16)00163-x - DOI - PubMed
    1. Zaidat OO, Lazzaro M, McGinley E, Edgell RC, Nguyen T, Linfante I, et al. Demand-supply of neurointerventionalists for endovascular ischemic stroke therapy. Neurology (2012) 79(13 Suppl 1):S35–41.10.1212/WNL.0b013e31826957ef - DOI - PubMed
    1. Saver JL, Levy E, McDougall CG, Moran CJ, Snyder KV, Houser G, et al. Planning for nationwide endovascular acute ischemic stroke care in the united states: report of the interventional stroke workforce study group. The Stroke Interventionalist (2012) 1(1):19–24.