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Prehospital Prediction of Large Vessel Occlusion in Suspected Stroke Patients

  • Cardiovascular Disease and Stroke (S. Prabhakaran, Section Editor)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Recent advances in endovascular thrombectomy have made acute ischemic stroke due to a large vessel occlusion more treatable than ever. Rapid access to treatment remains paramount and multiple large vessel occlusion prediction scales have been created to enhance prehospital identification and triage of these patients. This review summarizes the current state of large vessel occlusion prediction scales, proposes a set of ideal scale features, and discusses the future of these scales and prehospital neurological emergency response systems.

Recent Findings

A meta-analysis of the available data concluded that none of the currently published scales are more accurate than the others. However, other studies provide insight into important qualitative features beyond accuracy. At present, only a few large vessel occlusion prediction scales have been studied in the necessary prehospital suspected stroke patient population. Among these small studies, 26–51% of patients identified by scales had large vessel occlusions and 63–84% qualified for triage to a Comprehensive Stroke Center.

Summary

Valuable scale features include binary scoring, inclusion of gaze deviation and arm weakness, exclusion of neglect, and prehospital validation in a suspected stroke cohort. Patients with neurological emergencies that mimic large vessel occlusion, such as intracranial hemorrhage, may also benefit from triage to Comprehensive Stroke Centers. Prehospital triage is more complex than ever and guidelines, tools, and systems continue to evolve.

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Authors and Affiliations

  1. Department of Neurology , University of California, San Francisco, 505 Parnassus Ave, Box 0114, San Francisco, CA, 94143, USA

    Kevin J. Keenan

  2. University of Cincinnati Gardner Neuroscience Institute, Cincinnati, OH, USA

    Charles Kircher

  3. Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA

    Charles Kircher & Jason T. McMullan

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  1. Kevin J. Keenan
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Correspondence to Kevin J. Keenan.

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Conflict of Interest

Jason McMullan is part of the research team that developed and tested the Cincinnati Stroke Triage Assessment Tool. Previous work was supported by institutional (intramural) grants and philanthropic gifts, with no current funding. Kevin Keenan and Charles Kircher declare no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Cardiovascular Disease and Stroke

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Keenan, K.J., Kircher, C. & McMullan, J.T. Prehospital Prediction of Large Vessel Occlusion in Suspected Stroke Patients. Curr Atheroscler Rep 20, 34 (2018). https://doi.org/10.1007/s11883-018-0734-x

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