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

Objective The 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. Methods Patients 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. Results A 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). Conclusions Among patients with AIS-LVO who delay seeking medical attention for more than 24 hours, large artery atherosclerosis appears to be the predominant pathogenesis. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial N ### Funding Statement This study was supported by National Health commission capacity building and continuing education center GWJJ2021100203 and Beijing Health Promotion Association. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Zhangzhou Municipal Hospital Ethics Committee. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable All datasets generated for this study are included in the article/supplementary material.