Multicenter Study on the Frequency of Large Vessel Occlusion in Patients with Minor Stroke

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INTRODUCTION: The management of minor ischemic stroke presents significant challenges due to variability in the application of neuroimaging protocols and endovascular treatment (EVT). The lack of consensus on the need for computed tomography angiography (CTA) in these cases highlights the importance of investigating the prevalence and clinical implications of large vessel occlusion (LVO) in this population. METHODOLOGY: Analysis of the multicenter CODICT registry in patients with minor ischemic stroke (National Institutes of Health Stroke Scale (NIHSS) score ≤5) treated at tertiary stroke alert (SA) centers in the Valencian Community between July 1, 2020 and November 30, 2023. The frequency of LVO, defined as occlusions in the internal carotid artery, vertebral artery, basilar artery, and critical segments of the middle (M1, M2), anterior (A1, A2), and posterior (P1, P2) cerebral arteries, was evaluated using CTA. RESULTS: A total of 5473 SA activations were identified during the study period. A total of 833 patients suffered a minor ischemic stroke. LVO was observed in 17.5% (n = 146) of minor strokes on CTA. EVT was performed in 48.6% (n = 71) of patients with minor stroke and LVO. The most frequently occluded vessels were the middle cerebral artery (MCA) in its M1 and M2 segments, both in 35.6% (n = 52) of cases. However, the vessels most frequently treated with EVT were in the M1, in 29.5% (n = 43) of cases, followed by the M2, in 10.9% (n = 16) of cases. CONCLUSIONS: This study highlights the importance of performing CTA in all patients who meet SA activation criteria, regardless of clinical severity. The presence of LVO changed the clinical management in almost half of the patients with minor stroke and LVO.

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