Percentage of acute stroke patients eligible for endovascular treatment

Endovascular treatment for acute ischemic stroke has the potential to substantially improve the outcome for select individual stroke patients. However, the impact of this treatment on a population scale is unknown. We reviewed the epidemiology of acute stroke presentation times to estimate the proportion of patients with ischemic stroke who may be eligible for intra-arterial treatment. Experience with IV thrombolysis suggests that time from symptom onset is likely to be among the major exclusion criteria for intra-arterial treatment. Studies reviewed suggest that between 5% and 13% of patients with ischemic stroke present in the commonly recommended intra-arterial treatment window of 3 to 6 hours. Because of clinical exclusion factors other than time, the proportion of stroke patients eligible for intra-arterial treatment is likely even lower than these estimates. Clinicians and researchers should consider this a modest proportion of eligible patients when planning future studies and creating referral networks for endovascular stroke treatment.