BACKGROUND
Stroke is the second leading cause of death globally with 12.2 million new strokes occurring worldwide in 2019 causing 6.5 million deaths and resulting in the loss of 143 million disability-adjusted life years.1 Ischemic strokes accounted for 62.4% of strokes with estimates that 15-40% of acute ischemic strokes (AIS) are caused by large vessel occlusion.1, 2 There are significant disparities in global access to stroke management techniques such as mechanical thrombectomy and thrombolysis. This disparity is highlighted by the World Stroke Organization that noted that 89% of global stroke disability and deaths combined affect patients living in low–middle-income countries.3 Data on regional management of patients with neurotrauma and their outcomes based on country human development index4 can be used to inform global efforts to improve the care of patients with traumatic brain injuries (TBI) and minimize the morbidity and mortality globally associated with TBI.
Objective
Our objective for this project is to provide a snapshot of the current global management and outcomes of AIS secondary to large vessel occlusion. We will accomplish this by 1) determining the systems process of sites caring for patients with AIS, 2) describing differences in clinical management of patients with AIS, and 3) documenting 30-day outcomes of patients with AIS. This supports our long-term objective of bringing modern, evidence-based, stroke management techniques to areas that demonstrate the most significant need and opportunity for morbidity and mortality reduction. These objectives will support our big-picture mission of helping to reduce the global burden of stroke.
Methods
This study is an international, prospective, observational cohort study. Any hospital or clinic responsible for managing patients with AIS will be eligible to participate in this study. International sites will participate and prospectively collect data on patients presenting with AIS during a pre-defined 30-day enrollment period. Enrolled patients will be followed until death, discharge or up to 30 days from stroke onset (whichever comes first). Basic demographics, clinical management, and short-term outcomes will be recorded. Deidentified data will be collected by the central site for analysis and publication. The primary outcome of this study will be mortality at discharge or 30 days, whichever comes first. Secondary outcomes will include initial treatment of AIS, discharge modified Rankin score (mRS), and 30-day mRS (where available).
References
1.Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021;20(10):795-820. Epub 20210903.
2. Rai AT, Seldon AE, Boo S, Link PS, Domico JR, Tarabishy AR, Lucke-Wold N, Carpenter JS. A population-based incidence of acute large vessel occlusions and thrombectomy eligible patients indicates significant potential for growth of endovascular stroke therapy in the USA. J Neurointerv Surg. 2017;9(8):722-6. Epub 20160715.
3.Feigin VL, Brainin M, Norrving B, Martins S, Sacco RL, Hacke W, Fisher M, Pandian J, Lindsay P. World Stroke Organization (WSO): Global Stroke Fact Sheet 2022. Int J Stroke. 2022;17(1):18-29.
4. Clark D, Joannides A, Adeleye AO, Bajamal AH, Bashford T, Biluts H, Budohoski K, Ercole A, Fernández-Méndez R, Figaji A, Gupta DK, Härtl R, Iaccarino C, Khan T, Laeke T, Rubiano A, Shabani HK, Sichizya K, Tewari M, Hutchinson P. Casemix, management, and mortality of patients rreseceiving emergency neurosurgery for traumatic brain injury in the Global Neurotrauma Outcomes Study: a prospective observational cohort study. Lancet Neurol. 2022;21(5):438-49.