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Multicenter Study
. 2025 Apr 3;80(3):33477.
doi: 10.31083/RN33477.

[Multicenter Study on the Frequency of Large Vessel Occlusion in Patients with Minor Stroke]

[Article in Spanish]
Pablo Ros-Arlanzón  1   2 , Diego Corona García  1   2 , Raquel Hernández Lorido  1   2 , Isabel Beltrán Blasco  1   2 , José Tembl Ferrairo  3 , Cristina Soriano Soriano  4 , Nicolás López Hernández  1   2
Affiliations
Multicenter Study

[Multicenter Study on the Frequency of Large Vessel Occlusion in Patients with Minor Stroke]

[Article in Spanish]
Pablo Ros-Arlanzón et al. Rev Neurol. .

Abstract
in English, Spanish

Introduction: The management of minor ischemic stroke presents significant challenges due to variability in the application of neuroimaging protocols and endovascular treatment (EVT). The lack of consensus on the need for computed tomography angiography (CTA) in these cases highlights the importance of investigating the prevalence and clinical implications of large vessel occlusion (LVO) in this population.

Methodology: Analysis of the multicenter CODICT registry in patients with minor ischemic stroke (National Institutes of Health Stroke Scale (NIHSS) score ≤5) treated at tertiary stroke alert (SA) centers in the Valencian Community between July 1, 2020 and November 30, 2023. The frequency of LVO, defined as occlusions in the internal carotid artery, vertebral artery, basilar artery, and critical segments of the middle (M1, M2), anterior (A1, A2), and posterior (P1, P2) cerebral arteries, was evaluated using CTA.

Results: A total of 5473 SA activations were identified during the study period. A total of 833 patients suffered a minor ischemic stroke. LVO was observed in 17.5% (n = 146) of minor strokes on CTA. EVT was performed in 48.6% (n = 71) of patients with minor stroke and LVO. The most frequently occluded vessels were the middle cerebral artery (MCA) in its M1 and M2 segments, both in 35.6% (n = 52) of cases. However, the vessels most frequently treated with EVT were in the M1, in 29.5% (n = 43) of cases, followed by the M2, in 10.9% (n = 16) of cases.

Conclusions: This study highlights the importance of performing CTA in all patients who meet SA activation criteria, regardless of clinical severity. The presence of LVO changed the clinical management in almost half of the patients with minor stroke and LVO.

Introducción: El manejo del ictus isquémico minor presenta desafíos significativos, debido a la variabilidad en la aplicación de protocolos de neuroimagen y tratamiento endovascular (TEV). La ausencia de consenso sobre la indicación de la angiografía por tomografía computarizada (angioTC) en estos casos subraya la importancia de investigar la prevalencia y las implicaciones clínicas de la oclusión de gran vaso en esta población. Metodología: Análisis del registro multicéntrico CODICT en pacientes con ictus isquémico minor (National Institutes of Health Stroke Scale (NIHSS) ≤5) atendidos en centros terciarios de atención al código ictus (CI) de la Comunidad Valenciana en el periodo 01/07/2020–30/11/2023. Se evaluó la frecuencia de oclusión de gran vaso (OGV), definida como oclusiones en carótida interna, arteria vertebral, basilar, y segmentos críticos de la arteria cerebral media (M1, M2), anterior (A1, A2) y posterior (P1, P2), mediante angioTC. Resultados: Se identificaron un total de 5473 activaciones de CI en el periodo de estudio. Un total de 833 pacientes sufrieron un ictus isquémico minor. El 17,5% (n = 146) de los ictus minor mostraron una OGV en el angioTC. El 48,6% (n = 71) de los pacientes con ictus minor y OGV fueron sometidos a TEV. Los vasos más frecuentemente ocluidos fueron la arteria cerebral media (ACM) en sus segmentos M1 y M2 ambos en el 35,6% (n = 52) de los casos. Sin embargo, el vaso más frecuentemente tratado mediante TEV fue M1 en el 29,5% (n = 43), seguido por M2 en el 10,9% (n = 16) de los casos. Conclusiones: Este estudio pone de manifiesto la importancia de la realización de angioTC en todo paciente que cumpla criterios de activación de Código Ictus, independientemente de la gravedad clínica. La presencia de OGV cambió el manejo clínico en casi la mitad de los pacientes con ictus minor y OGV.

Keywords: computed tomography angiography; large vessel occlusion; minor stroke; stroke.

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Conflict of interest statement

Los autores declaran no tener conflictos de interés.

Figures

Fig. 1.
Fig. 1.
Flujo de pacientes y proporción de pacientes con ictus minor con oclusión de gran vaso. CI, código ictus; OGV, oclusión de gran vaso; TEV, tratamiento endovascular; mRS, escala de Rankin modificada; NIHSS, National Institutes of Health Stroke Scale.
See this image and copyright information in PMC

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