Prevalence of Large Vessel Occlusion Across Contemporary Stroke Care Settings: A Systematic Review and Meta-Analysis
12 affiliations
- 1Department of Neurology (A.B., N.A., W.D.H., S.O.-G.), University of Iowa Health Care, Iowa City.
- 2Department of Biostatistics, College of Public Health, University of Iowa (F.H.-C.), University of Iowa Carver College of Medicine, Iowa City.
- 3Department of Emergency Medicine (A.Z., N.M.M.), University of Iowa Carver College of Medicine, Iowa City.
- 4Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City (A.Z.).
- 5Cerebrovascular Disorders Unit, Neurology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.O.).
- 6Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at University of California, Los Angeles (J.L.S.).
- 7Stroke Unit, Neurology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain (M.R.).
- 8Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City (D.S.).
- 9Department of Biostatistics, College of Public Health, University of Iowa, Iowa City (G.B.).
- 10Department of Anesthesia Critical Care (N.M.M.), University of Iowa Carver College of Medicine, Iowa City.
- 11Department of Neurosurgery (S.O.-G.), University of Iowa Health Care, Iowa City.
- 12Department of Radiology (S.O.-G.), University of Iowa Health Care, Iowa City.
Abstract
Background
In the post-late-window thrombectomy era, reliable characterization of the range of large vessel occlusion (LVO) prevalence is essential to inform stroke systems of care, prehospital triage strategies, and population-level modeling. We conducted a systematic review and meta-analysis to characterize the distribution of reported LVO prevalence across contemporary acute ischemic stroke (AIS) care environments and to summarize context-specific estimates.Methods
We searched PubMed, Embase, and Cochrane Library for articles published between January 1, 2018, and August 25, 2025, that reported the prevalence of LVO among adult patients with AIS. Random-effects meta-analysis was used to summarize the distribution of reported study-level LVO prevalence across heterogeneous care settings rather than to estimate a single common prevalence. Subgroup analyses were performed according to country income level, mode of hospital arrival, and diagnostic category in suspected stroke cohorts.Results
A total of 18 studies were included, comprising 460 176 patients with AIS, of whom 135 315 patients had LVO. Reported study-level LVO prevalence ranged from 11.2% to 40%. The random-effects summary across all included care environments was 23.1% (95% CI, 19.6-27.03). Studies from high-income countries yielded a pooled LVO prevalence of 23.8% (95% CI, 20.3-27.7). In suspected stroke/stroke-alert populations, the estimated prevalence of AIS was 54.6% (95% CI, 44.3-64.5), hemorrhagic strokes were 12.3% (95% CI, 9.8-15.4), and stroke mimics were 23.3% (95% CI, 14.5-35.2). Among emergency medical services transported patients, the estimated prevalence of LVO was 29.3% (95% CI, 24.6-34.4).Conclusions
Across contemporary studies, LVO prevalence among AIS populations varied widely by care environment. The overall estimate of ≈1 in 4 should be interpreted as a summary across heterogeneous care settings rather than a single true prevalence. Higher LVO prevalence in patients transported by emergency medical services and prehospital triage-selected populations highlights the need for context-specific estimates when developing stroke triage strategies and destination decision tools.
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BibTeX
@article{brito2026prevalence,
title = {{Prevalence of Large Vessel Occlusion Across Contemporary Stroke Care Settings: A Systematic Review and Meta-Analysis}},
author = {Anderson Brito and Nashwa Abdelhakim and William Davis Haselden and Ferney Henao-Ceballos and Anne Zepeski and Natalia Perez de la Ossa and Jeffrey L Saver and Marc Ribo and Dan Shane and Grant Brown and Nicholas M Mohr and Santiago Ortega-Gutierrez and STROKE Investigators},
journal = {Stroke (Hoboken, N.J.)},
year = {2026},
month = sep,
doi = {10.1161/svin.126.002576},
url = {https://europepmc.org/article/PMC/PMC13727255},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Prevalence of Large Vessel Occlusion Across Contemporary Stroke Care Settings: A Systematic Review and Meta-Analysis
AU - Anderson Brito
AU - Nashwa Abdelhakim
AU - William Davis Haselden
AU - Ferney Henao-Ceballos
AU - Anne Zepeski
AU - Natalia Perez de la Ossa
AU - Jeffrey L Saver
AU - Marc Ribo
AU - Dan Shane
AU - Grant Brown
AU - Nicholas M Mohr
AU - Santiago Ortega-Gutierrez
AU - STROKE Investigators
PY - 2026
DA - 2026/09/24
JO - Stroke (Hoboken, N.J.)
DO - 10.1161/svin.126.002576
UR - https://europepmc.org/article/PMC/PMC13727255
AB - Background In the post-late-window thrombectomy era, reliable characterization of the range of large vessel occlusion (LVO) prevalence is essential to inform stroke systems of care, prehospital triage strategies, and population-level modeling. We conducted a systematic review and meta-analysis to characterize the distribution of reported LVO prevalence across contemporary acute ischemic stroke (AIS) care environments and to summarize context-specific estimates.Methods We searched PubMed, Embase, and Cochrane Library for articles published between January 1, 2018, and August 25, 2025, that reported the prevalence of LVO among adult patients with AIS. Random-effects meta-analysis was used to summarize the distribution of reported study-level LVO prevalence across heterogeneous care settings rather than to estimate a single common prevalence. Subgroup analyses were performed according to country income level, mode of hospital arrival, and diagnostic category in suspected stroke cohorts.Results A total of 18 studies were included, comprising 460 176 patients with AIS, of whom 135 315 patients had LVO. Reported study-level LVO prevalence ranged from 11.2% to 40%. The random-effects summary across all included care environments was 23.1% (95% CI, 19.6-27.03). Studies from high-income countries yielded a pooled LVO prevalence of 23.8% (95% CI, 20.3-27.7). In suspected stroke/stroke-alert populations, the estimated prevalence of AIS was 54.6% (95% CI, 44.3-64.5), hemorrhagic strokes were 12.3% (95% CI, 9.8-15.4), and stroke mimics were 23.3% (95% CI, 14.5-35.2). Among emergency medical services transported patients, the estimated prevalence of LVO was 29.3% (95% CI, 24.6-34.4).Conclusions Across contemporary studies, LVO prevalence among AIS populations varied widely by care environment. The overall estimate of ≈1 in 4 should be interpreted as a summary across heterogeneous care settings rather than a single true prevalence. Higher LVO prevalence in patients transported by emergency medical services and prehospital triage-selected populations highlights the need for context-specific estimates when developing stroke triage strategies and destination decision tools.
SN - 2694-5746
ER -