Incidence of Acute Ischemic Stroke With Visible Arterial Occlusion

Abstract

Background and Purpose: Because of several methodological limitations, previous studies focusing on the prevalence of large vessel occlusion in ischemic stroke (IS) patients provided conflicting results. We evaluated the incidence of IS with a visible arterial occlusion using a comprehensive population-based registry. Methods: Patients with acute IS were prospectively identified among residents of Dijon, France, using a population-based registry (2013–2017). All arterial imaging exams were reviewed to assess arterial occlusion. Annual incidence rates of IS (first-ever and recurrent events) and IS with a visible occlusion were calculated. Results: One thousand sixty cases of IS were recorded (mean age: 76.0±15.8 years, 53.9% women). Information about arterial imaging was available in 971 (91.6%) of them, and only preexisting dementia was independently associated with having missing information (odds ratio=0.34 [95% CI, 0.18–0.65], P =0.001). Among these patients, 284 (29.2%) had a visible arterial occlusion. Occlusion site was the anterior circulation in 226 patients (23.3% of overall patients with available data) and the posterior circulation in 58 patients (6.0%). A proximal occlusion of the anterior circulation was observed in 167 patients (17.2%). The crude annual incidence rate of total IS per 100 000 was 138 (95% CI, 129–146). Corresponding standardized rates were 66 (95% CI, 50–82) to the World Health Organization and 141 (95% CI, 118–164) to the 2013 European populations. The crude annual incidence rate of IS with a visible arterial occlusion per 100 000 was 37 (95% CI, 33–41) and that of IS with a proximal occlusion of the anterior circulation was 22 (95% CI, 18–25). Corresponding standardized rates were 18 (95% CI, 10–26) and 10 (95% CI, 8–13) to the World Health Organization population, and 38 (95% CI, 26–50) and 23 (95% CI, 19–26) to the 2013 European population, respectively. Conclusions: These results will be helpful to plan the need for thrombectomy-capable stroke center resources.

Stroke risk, phenotypes, and death in COVID-19

“…Indeed, the observed overall 46.9% prevalence of LVO in the whole cohort of ischemic stroke patients was almost twice higher than the 29.2% recently reported in a population-based study. 27 Similarly, 68.8% of ischemic stroke patients <50 years old in our study had an LVO compared to 29.7% in the same population-based study. 27 The high prevalence of LVO in the context of a low burden of comorbidities in young COVID-19 patients with stroke strongly supports the role of hypercoagulability as a cause of arterial thrombosis in this age group.…”

“…27 Similarly, 68.8% of ischemic stroke patients <50 years old in our study had an LVO compared to 29.7% in the same population-based study. 27 The high prevalence of LVO in the context of a low burden of comorbidities in young COVID-19 patients with stroke strongly supports the role of hypercoagulability as a cause of arterial thrombosis in this age group. This concept is further reinforced by the over 4x higher proportion of cases with elevated D-Dimer in our cohort of patients with ischemic stroke (82.7%) and particularly among young patients (90.0%) compared to the overall reported prevalence among COVID-19 patients (20.4%).…”

Distribution of Diagnoses and Clinical and Imaging Characteristics in 1,322 Consecutive Suspected Stroke Patients

“…EVT was performed in 15 patients (5%) and i.v.-tPA was administered in 48 (16%) of the ischemic strokes. ASPECTS was very low (0–3) in 1 patient (2.1%), low ( 4 , 5 ) in 2 patients (4.2%), medium ( 6 – 8 ) in 10 patients (20.8%), and high ( 9 , 10 ) in 35 patients (72.9%) with an occlusion in the anterior circulation.…”

“…A major issue among them is the lack of reliable data on the percentage of stroke patients eligible for EVT and their characteristics. Even though the number of patients with large-vessel occlusions and occlusions of the M2 segment of the middle cerebral artery has been estimated ( 2 – 5 ), detailed information about further characteristics such as frequency of stroke mimics and intracranial hemorrhages is lacking. Moreover, the available information is mostly confined to large-vessel occlusion strokes, but in times of expanding indications for EVT ( 6 ), the frequency of more medium-vessel occlusions, the distribution of Alberta Stroke Program Early Computed Tomography Score (ASPECTS), the time window of presentation, and the National Institutes of Health Stroke Scale (NIHSS) of those patients are also of crucial importance for planning thrombectomy resources.…”

Frequency and Timing of Endovascular Therapy in Acute Stroke Patients: A Population-Based Analysis Using the Bremen Stroke Register

“…Using data from a tertiary level hospital in the USA serving a large geographic area, Rai and colleagues [6] reported an incidence of LVOs in thrombectomy eligible patients of 24 per 100,000 person-years. In a recent analysis of the Dijon Stroke Registry, the rate of proximal LVO s within the anterior circulation was 22 (95% CI: 18–25) per 100,000 person-years [13].…”