Ischemic Strokes Due to Large-Vessel Occlusions Contribute Disproportionately to Stroke-Related Dependence and Death:
Konark Malhotra1, Jeffrey Gornbein2, Jeffrey L Saver3
1Department of Neurology, West Virginia University, Charleston Division, Charleston, WV, United States.
Insights
Large-vessel occlusion (LVO) acute ischemic strokes (AIS) cause severe disability and death. Endovascular thrombectomy (ET) significantly reduces these severe outcomes, offering disproportionate benefits at the population level.
Area of Science:
- Neurology
- Cardiovascular Diseases
- Public Health
Background:
- Large-vessel occlusion (LVO) acute ischemic strokes (AIS) are linked to more severe patient deficits.
- Endovascular thrombectomy (ET) is hypothesized to disproportionately benefit patients experiencing stroke-related dependence and death.
Purpose of the Study:
- To assess the impact of LVO-AIS on stroke-related dependence and mortality.
- To determine the population-level benefit of ET in reducing severe stroke outcomes.
Main Methods:
- Systematic literature search for studies comparing dependence or death (modified Rankin Scale 3-6) and mortality in LVO-AIS versus non-LVO ischemic stroke patients.
- Inclusion of consecutive patients presenting within 24 hours of symptom onset.
Main Results:
- LVO-AIS patients had higher rates of dependence or death (64% vs. 24%) and mortality (26.2% vs. 1.3%) compared to non-LVO patients.
- While LVO-AIS constitutes 38.7% of acute ischemic strokes, it accounts for 61.6% of post-stroke dependence/death and 95.6% of post-stroke mortality.
- ET, applicable to 21.4% of LVO patients, accounts for 34% of post-stroke dependence/death and 52.8% of post-stroke mortality.
Conclusions:
- LVOs are responsible for a significant majority of severe stroke outcomes (dependence and mortality) despite representing only about one-third of acute ischemic strokes.
- Endovascular thrombectomy demonstrates a disproportionate benefit in mitigating severe stroke outcomes at the population level.
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.
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