Factors influencing the delayed presentation of patients with large vessel occlusion in acute ischemic stroke

ObjectiveThe benefit of treatment for patients with large vessel occlusion (LVO) in acute ischemic stroke (AIS) is associated with timely access to reperfusion therapy. This study aimed to analyze the factors associated with delayed access to medical attention among patients with AIS-LVO. MethodsPatients with acute ischemic stroke admitted to the cerebrovascular intervention department of Zhangzhou Hospital, Fujian Province, China, from September 1, 2020 to September 1, 2022, were enrolled in this study. Patients with AIS-LVO were divided into two groups based on whether they visited the hospital for more than 24 hours. Demographic data, NIHSS scores, clinical and radiological data, and in-hospital flow time were collected. Differences between the two groups were analyzed, and univariate and multivariate analyses were performed to identify factors associated with delayed presentation. ResultsA total of 1396 patients were included in the study, with 218 in the delayed group and 1178 in the non-delayed group. There were no significant differences between the two groups in terms of age, gender, or education level. However, the delayed group had a higher proportion of patients living alone (P<0.05). Regarding stroke risk factors, hypertension (83.5% vs 69.9%, P<0.001), diabetes mellitus (35.8% vs 26.1%, P=0.047), and smoking (39.5% vs 28.0%, P=0.020) were more prevalent in the delayed group compared with the non-delayed group. Conversely, the non-delayed group had a higher incidence of atrial fibrillation (37.5% vs 12.8%, P<0.001). After multivariate regression analysis, the independent predictors for the delay group were solitary OR=11.10 (95% CI 5.72-21.5), large artery atherosclerosis OR=2.63 (95% CI 1.40-4.94), presence of atrial fibrillation OR=0.41 (95% CI 0.19-0.87), and involvement of the middle cerebral artery OR=0.51 (95% CI 0.32-0.81). ConclusionsAmong patients with AIS-LVO who delay seeking medical attention for more than 24 hours, large artery atherosclerosis appears to be the predominant pathogenesis.