Trends in Cerebral Large Vessel Occlusions: The "Clustering" of Strokes at Henry Ford Health System
Rizwan A Tahir Travis Hamilton Ayesha Ahmad Horia Marin Maximillian K Kole
Henry Ford Health System
Introduction: Several studies have examined trends of ischemic stroke and its association with medical, environmental, meteorological, social and economic factors in micropopulations. We investigated ..
Introduction: Several studies have examined trends of ischemic stroke and its association with medical, environmental, meteorological, social and economic factors in micropopulations. We investigated these factors and their association with large vessel occlusions (LVOs) that underwent mechanical thrombectomy at a certified comprehensive stroke center. Methods: A retrospective analysis was conducted of LVOs which underwent mechanical thrombectomy for reperfusion during a four-year period (2015-2018) to determine if a "clustering" phenomenon was present and if an association with several meteorological and social factors pertinent to the field of stroke neurology was present. Barometric pressure, temperature, dew point, humidity, and planetary A-Index were all analyzed using simple logistic regression to determine if an association was present with LVOs requiring mechanical thrombectomy for the years 2015-2018, and with all years combined. Results: 301 mechanical thrombectomies were performed during the study time period. For the year 2017, a "clustering" phenomenon was present with 89 (85%) of endovascular cases accusing within 48 hours of another endovascular case, as well as in 2018 with 114 (88%) of cases occurring within 48 hours of another case. No statistically significant association was observed in relation to LVOs requiring endovascular intervention and barometric pressure change, temperature, humidity, dew point, or planetary A-Index. While a slightly larger change in atmospheric pressure was observed in the 48-hour window prior to an LVO requiring endovascular intervention, these results were not statistically significant. Similarly, LVOs requiring endovascular intervention occurred more frequently during a 48-hour window of elevated planetary A-Index but these results were not consistent over the study time period. There was a significant increase in the number of mechanical thrombectomies performed after the early results of both the DAWN trial and DEFUSE-3 trial were published. Conclusions: Over a four-year span, no statistically significant association between meteorological, environmental, or social factors and LVOs requiring endovascular intervention was observed. While a "clustering" pattern of stroke occurrence observed at our institution may be generated by an external influence, no identifiable cause/mechanism of action was discovered.