There are class 1 recommendations for the management of common stroke risk factors such as atrial fibrillation (AF), hyperlipidemia (HLD), hypertension (HTN), diabetes (DM), and vascular disease however many of these risk factors remain uncontrolled in patients presenting with acute stroke.

A retrospective chart review was conducted on patients undergoing endovascular therapy (EVT) from 2012-2019. Data was collected on risk factors present prior to admission including HTN, DM, HLD, AF, and smoking.  Preventable stroke was defined as having at least one of the following: untreated AF, untreated HLD, poorly controlled HTN (left ventricular hypertrophy on transthoracic echo), vascular disease not on an antiplatelet agent, poorly controlled DM (A1c>10), current smoking. Groups were compared based on age, sex and 90 day functional outcomes, with favorable outcome defined as mRS ≤ 2.

Our sample included 396 patients who underwent EVT  (mean age 65, 50% female). 42% of patients with Afib were not on anticoagulation, 31% of patients with HLD were untreated, 39% of patients with HTN were poorly controlled, 27% of patients with a history of vascular disease were not on an antiplatelet, 14% of patients with DM were poorly controlled, and 46% of patients were smokers. In total, 78% of patients had at least 1 poorly controlled risk factor. There was no difference in rates of preventable stroke between males and females (48% vs 52%, p=0.30). 64% of patients with well controlled risk factors had favorable outcomes compared to 51% with at least one poorly controlled risk factor (p=0.03).

Many risk factors are poorly controlled prior to admission for large vessel stroke.  Improving primary prevention could save the resources utilized in EVT and may influence long term outcomes in these patients.