Prevalence of Large Vessel Occlusion (LVO) in Latin American Patients with Acute Ischemic Stroke: A Systematic Review and Meta-Analysis
Niels Pacheco1, Karlos Acurio2, Fritz Vascones Roman2, Wagner Rios-Garcia3, Zinnia Brenda Cuyotupa Cosme4, Irving Calisaya-Madariaga2, Andre Lapeyre Rivera5, Diana Carolina Salazar Flores2, Ariana Alvarez-Rojas2, Lyan Chang2, Carlos Rodrigo Vicuña5, Olivier Uwishema6
1Harvard Medical School, 2Universidad Peruana Cayetano Heredia, 3Universidad San Luis Gonzaga, 4Universidad Nacional de Ucayali, 5Universidad Nacional Mayor de San Marcos, 6Oli Health Magazine Organization(OHMO)
Objective:
To summarize the current evidence about prevalence and risk factors of LVO in Latin America patients with acute ischemic stroke.
Background:
LVOs usually represent up to 30% of ischemic strokes, showing a similar incidence in Latin American populations, and their management may vary according to access to specialized diagnosis and treatment, for which reason the evidence is scarce.
Design/Methods:
We systematically searched 6 databases up to July 2024 for studies evaluating Latin America patients with acute ischemic stroke that develop a LVO. A meta-analysis using a random-effects model to estimate pooled effects was planned for each outcome and a narrative synthesis when this was not possible. The risk of bias was assessed according to Joanna Briggs Institute (JBI) guidelines for prevalence studies and GRADE criteria were used to identify the certainty of evidence (CoE).
Results:
After selection, we included 17 studies with a higher number of men (52.6%) and an average age of 62.5 years. All studies had a low risk of bias. The overall prevalence of LVO was 92.0% (13221 participants; 95% CI: 63.0%-99.0%; I2 = 98%; CoE very low), with a higher proportion in Brazil (96.0%; 12 studies; 5441 participants; 95% CI: 78.0%-99.0%; I2 = 97%; CoE very low). At 3 months, 20.0% died (1765 participants; 95% CI: 11.0%-31.0%; I2 = 97%; CoE very low) and only 46% had a good prognosis (2269 participants; 95% CI: 35.0%-57.0%; I2 = 96%; CoE very low).
Conclusions:
We found that almost all patients with acute ischemic stroke were due to LVO and that less than half of the patients had favorable outcomes at 3 months; however, the very low certainty and small number of studies indicate that further studies should be conducted to corroborate our results.
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