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Review
. 2025 Jun 2:15910199251345631.
doi: 10.1177/15910199251345631. Online ahead of print.

Diagnostic value of non-invasive large vessel occlusion detection methods: A systematic review and meta-analysis

Seyed Behnam Jazayeri  1 , Mohammad Mehdi Mehrabi Nejad  2 , Sherief Ghozy  3   4 , Noha Hamouda  5 , Baria Ahmad  6 , Ramanathan Kadirvel  3   4 , David F Kallmes  3
Affiliations
Review

Diagnostic value of non-invasive large vessel occlusion detection methods: A systematic review and meta-analysis

Seyed Behnam Jazayeri et al. Interv Neuroradiol. .

Abstract

BackgroundAccurate and timely prehospital detection of large vessel occlusion (LVO) is critical for optimizing patient triage and initiating appropriate reperfusion therapies. Recent advances in portable stroke detection technologies, such as electroencephalography (EEG) and transcranial Doppler (TCD) ultrasound, offer potential solutions but their diagnostic performance remains unclear.MethodsWe searched PubMed, Scopus, Embase, and Web of Science, following the PRISMA guidelines. Studies were included if they assessed the diagnostic performance of non-invasive prehospital LVO detection tools compared to CT or MR angiography. Risk of bias was assessed using the QUADAS-2 tool.ResultsA total of 13 studies were included, examining various portable detection tools including EEG or neurophysiological monitoring, ultrasound-based techniques including TCD or TCCD, portable Openwater optical blood flow monitor and cranial accelerometry. The pooled diagnostic odds ratio (DOR) was 52.7 (95% CI: 28.3-97.8), indicating strong diagnostic performance, with significant heterogeneity among studies (I2 = 67.3%, P < 0.001). Subgroup analysis revealed that TCD-based methods had the highest DOR (120.4, 95% CI: 76.9-188.7), followed by other tools (26.8, 95% CI: 13.7-52.6), and EEG (18.2, 95% CI: 9.1-36.3). The pooled sensitivity was 87.4% (95% CI: 82.5-91.0) and specificity was 89.39% (95% CI: 83.0-93.5) across all methods. TCD-based methods showed the highest specificity (95.0%, 95% CI: 91.8-97.0).ConclusionNon-invasive prehospital LVO detection tools show promising diagnostic performance, particularly TCD-based methods. Future studies should focus on validating these tools in larger, diverse populations to enhance prehospital stroke triage and improve patient outcomes.

Keywords: Doppler; Stroke; electroencephalography; emergency medical services; transcranial; triage; ultrasonography.

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Conflict of interest statement

The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: RK received research support from NIH, Cerenovus Inc, Medtronic, Endovascular Engineering, Insera Therapeutics, Frontior Bio, Sensome Inc, Endomimetics, Ancure LLC, Neurogami Medical, MIVI Biosciences, Monarch Biosciences, Stryker Inc, Piraeus Medical, MIVI Biosciences and Bionaut Labs.

DFK holds equity in Nested Knowledge, Superior Medical Editors, and Conway Medical, Marblehead Medical and Piraeus Medical. He receives grant support from MicroVention, Medtronic, Balt, and Insera Therapeutics; has served on the Data Safety Monitoring Board for Vesalio; and received royalties from Medtronic.

Figures

Figure 1.
Figure 1.
PRISMA flowchart of study selection.
Figure 2.
Figure 2.
Meta-analysis of diagnostic odds ratio based on non-invasive tools to detect LVO.
Figure 3.
Figure 3.
Meta-analysis of sensitivity of non-invasive tools to detect LVO.
Figure 4.
Figure 4.
Meta-analysis of specificity of non-invasive tools to detect LVO.
Figure 5.
Figure 5.
The SROC curve (bivariate model).
See this image and copyright information in PMC

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