• Masato Inoue, Ryuichi Noda, Shoji Yamaguchi, Yuta Tamai, Makiko Miyahara, Shunsuke Yanagisawa, Koichiro Okamoto, Tetsuo Hara, Sosuke Takeuchi, Kazunori Miki, and Shigeru Nemoto.
• Department of Neurosurgery, National Center for Global Health and Medicine, Tokyo, Japan. Electronic address: inmasato@hosp.ncgm.go.jp.
• J Stroke Cerebrovasc Dis. 2018 Apr 1; 27 (4): 886-891.

BackgroundThe effectiveness of thrombectomy for acute ischemic stroke has been established, and earlier treatment produces better outcomes. If possible to identify large-vessel occlusion (LVO) at the prehospital phase, eligible patients can be shipped directly to a hospital that can perform thrombectomy. The purpose of this study was to determine factors that are specific to LVO and can be known before hospital arrival.MethodsThe subjects were stroke patients during the period between July 2014 and June 2016, who had a National Institutes of Health Stroke Scale (NIHSS) score of 8 or higher and came to our hospital within 6 hours of onset. These patients were divided into an LVO group and a non-LVO group, and background factors, mode of onset, individual NIHSS item scores, and blood pressure at the time of the visit were retrospectively investigated. The selected factors were compared with LVO prediction scales reported in the past.ResultsThere were 196 stroke patients who had NIHSS scores of 8 or higher and arrived at the hospital within 6 hours. Of these 196 patients, 56 had LVO. This LVO group included a significantly higher number of patients with the 2 items of atrial fibrillation (odds ratio [OR], 11.5: 95% confidence interval [CI], 4.04-32.9; P < .0001) and systolic blood pressure of 170 mm Hg or lower (OR, 2.99: 95% CI, 1.33-6.71, P = .008). These 2 items predicted LVO equally to existing LVO prediction scales.ConclusionsThe 2 items of atrial fibrillation and systolic blood pressure of 170 mm Hg or lower were significantly correlated with LVO.Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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