Prevalence of Large Vessel Occlusion Across Contemporary Stroke Care Settings: A Systematic Review and Meta-Analysis
Anderson Brito, Nashwa Abdelhakim, William Davis Haselden, Ferney Henao-Ceballos, Anne Zepeski, Natalia Perez de la Ossa, Jeffrey L. Saver, Marc Ribo, Dan Shane, Grant Brown, Nicholas M. Mohr, Santiago Ortega-Gutierrez, Azeemuddin Ahmed, Marc Cohen, Brett Faine, Mudassir Farooqui, Jacob Oleson, Sven Steen, Richard VermeerBACKGROUND:
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.
METHODS:
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.
RESULTS:
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).
CONCLUSIONS:
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.