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Prevalence of Large Vessel Occlusion Across Contemporary Stroke Care Settings: A Systematic Review and Meta-Analysis

Anderson Brito N. Abdelhakim W. Haselden Ferney Henao-Ceballos A. Zepeski N. Pérez de la Ossa J. Saver M. Ribó Sha-Ne M. Dan Grant Brown N. Mohr S. Ortega-Gutierrez Azeemuddin Ahmed Marc Cohen B. Faine M. Farooqui Jacob Oleson Sven Steen R. Vermeer

Sep 2026 · Stroke: Vascular and Interventional Neurology · 0 citations · 28 references

Abstract

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. 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. 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). 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.

DOI Semantic Scholar

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