Large hemispheric infarction Market Insight

Key Highlights

• The Large hemispheric infarction (LHI) market is anticipated to experience steady growth during the forecast period (2024–2034). The increase in market size is driven by various factors such as the increasing incidence of LHI cases, and the rising awareness about the disease.
• The increasing incidence of large hemispheric infarction (LHI) cases can be attributed to several factors. Firstly, improvements in medical care and emergency response systems have led to more timely identification and diagnosis of stroke, including LHI. Additionally, an aging population and the rising prevalence of risk factors such as hypertension, diabetes, and obesity contribute to an increased overall incidence of stroke, including LHI. Changes in lifestyle factors such as sedentary behavior and unhealthy diet patterns may also play a role. Furthermore, advancements in neuroimaging techniques have enhanced detection of LHI cases that might have previously been missed or misdiagnosed. Overall, a combination of demographic shifts, lifestyle changes, and improved diagnostic capabilities likely contributes to the observed rise in LHI incidence.
• The current market is predominantly occupied by osmotic therapy and glucose and blood pressure management therapies. However, there is currently no US FDA-approved drug for LHI, and there are no emerging drugs in the pipeline as well. Consequently, there exists a pressing necessity for the development of new treatment options.

DelveInsight’s comprehensive report titled “Large hemispheric infarction (LHI) — Market Insights, Epidemiology, and Market Forecast – 2034” offers a detailed analysis of Large hemispheric infarction (LHI). The report presents historical and projected epidemiological data covering incident cases of large hemispheric infarction, age-specific cases of large hemispheric infarction, and treated cases of large hemispheric infarction. In addition to epidemiology, the market report encompasses various aspects related to the patient population. These aspects include the diagnosis process, prescription patterns, physician perspectives, market accessibility, treatment options, and prospective developments in the market across seven major markets: the United States, EU4 (Germany, France, Italy, and Spain), the United Kingdom, and Japan, spanning from 2020 to 2034.

The report analyzes the existing treatment practices and unmet medical requirements in LHI. It evaluates the market potential and identifies potential business prospects for enhancing therapies or interventions. This valuable information enables stakeholders to make well-informed decisions regarding product development and strategic planning for the market.

Large Hemispheric Infarction (LHI) Overview

LHI is a severe form of ischemic stroke affecting the majority of or complete middle cerebral artery (MCA) distribution area with or without anterior cerebral artery and posterior cerebral artery involvement and characterized by the development of life-threatening cerebral edema. LHI stroke pathogenesis is typically due to cardioembolism. LHI is commonly associated with varying degrees of brain swelling, with subsequently raised intracranial pressure, midline shift, and brain herniation, giving rise to the term malignant brain edema (MBE). Appropriate triage of LHI patients is important to provide an adequate level of care. It is used to describe total or partial anterior circulation infarct caused by occlusion of an internal carotid artery or the proximal middle cerebral artery (MCA), affecting a large portion of the MCA territory and constituting up to 10% of all supratentorial ischemic stroke.

Large Hemispheric Infarction (LHI) Diagnosis and Treatment Algorithm 

Diagnosis of LHI mainly consists of measurement of the stroke infarct volume to determine the extent of ischemic damage and confirm the presence of LHI. The diagnosis primarily relies on the use of diffusion-weighted imaging (DWI) to measure the stroke infarct volume which is done to confirm the presence of a large, hemispheric ischemic event. Diagnosis of LHI is very crucial because it is associated with a high likelihood of the development of life-threatening cerebral edema, which requires prompt recognition and management. 

The mainstay of supportive care for LHI is endotracheal intubation and mechanical ventilation for airway protection and a decreased level of consciousness. Patients with LHI are best managed in an ICU where mannitol infusion, hypertonic saline solution, and hyperventilation are mainstay treatments. Decompressive surgery is extremely helpful if performed early. Until recently, no pharmacological strategies have been proven effective by clinical trials. Decompressive hemicraniectomy conducted within 48 h after symptom onset has been proven effective for patients with LHI with MBE.

Large hemispheric infarction (LHI) Epidemiology

The epidemiology section of the LHI market report offers information on the patient populations, including historical and projected trends for each of the seven major markets. Examining key opinion leader views from physicians or clinical experts can assist in identifying the reasons behind historical and projected trends. The diagnosed patient pool, their trends, and the underlying assumptions are all included in this section of the report.

This section also presents the data with relevant tables and graphs, offering a clear and concise view of the incidence of LHI. Additionally, the report discloses the assumptions made during the analysis, ensuring data interpretation and presentation transparency. This epidemiological data is valuable for understanding the disease burden and its impact on the patient population across various regions.

Key Findings

As per our analysis, LHI, also known as malignant middle cerebral artery infarction (MMI), is one of the most malignant types of supratentorial ischemic stroke. It has an annual incidence of about 20 per 100,000 people and a mortality rate of around 30% to 80%.

As per the analysis, LHI cases were older than 60 years and lacunar infarctions were significantly more numerous in the 30- to 40-year age range compared with the 15- to 29-year age range.

As per our analysis, the incidence of LHI has been estimated to be around 2 to 8% of all hospitalized ischemic stroke and 10 to 15% of all MCA territory ischemic stroke. Cerebral edema associated with LHI can lead to transtentorial herniation, neurologic deterioration, and death in almost 40 to 80% if left untreated.

Based on our analysis, initial stroke severity (NIHSS or Glasgow coma scale score), involvement of the adjacent (anterior or posterior cerebral artery) territories, anisocoria, early neurological deterioration, coronary artery disease, and internal carotid artery occlusion were the predictors of mortality and poor functional outcome in patients with LHI.

Large Hemispheric Infarction (LHI) Market Outlook

The treatment regime for LHI includes endotracheal intubation and mechanical ventilation for airway protection and a depressed level of consciousness. Patients with LHI are best managed with mannitol infusion, hypertonic saline solution, and hyperventilation are mainstay treatments. Decompressive surgery is extremely helpful if performed early. 

Hyperventilation can be employed for immediate control of ICP elevation. This effect, however, is limited, and although the onset is within several seconds, this measure should be used as merely a bridging therapy until more aggressive measures can be engaged. Prolonged usage of hyperventilation can cause a paradoxical worsening of ischemia through prolonged vasoconstriction. Elevation of the head of the bed (HOB) to improve venous drainage and ICP elevation is standard practice. Glucose and Blood pressure management- Hyperglycemia in the setting of ischemia is associated with an increase in ICP and progression to hemorrhagic conversion. In the setting of LHI, there have been no specific studies suggesting that blood pressure management should differ from management in other ischemic stroke patients. The commonly used intravenous medications in acute stroke have been nicardipine, labetalol, sodium nitroprusside, enalapril, and hydralazine.

Osmotic therapy is generally employed for the treatment of existing cerebral edema and used for deteriorating patients with progressive cerebral edema. The agents predominantly utilized are mannitol and hypertonic saline. Decompression hemicraniectomy is the next step when medical therapy fails. Only 0.3% of all ischemic stroke patients may qualify for decompression hemicraniectomy.

With ongoing research and continued dedication, the future holds hope for even more effective treatments and, ultimately, a cure for this challenging condition. According to DelveInsight, the Large hemispheric infarction (LHI) market in the 7MM is expected to change significantly during the study period 2020–2034.

Large hemispheric infarction (LHI) Recent Developments

• In November 2024, Remedy Pharmaceuticals announced that following an October 16, 2024 Type C meeting with the FDA, they received valuable feedback on their Phase 3 trial design for CIRARA, an investigational drug for large hemispheric infarction (LHI), a severe form of ischemic stroke. The meeting provided key insights to guide the next steps in the clinical development of CIRARA.

Large hemispheric infarction (LHI) Market Segmentation

DelveInsight’s ‘Large hemispheric infarction (LHI) Market Insights, Epidemiology, and Market Forecast – 2034’ report provides a detailed outlook of the current and future Large hemispheric infarction (LHI) market, segmented within countries, by therapies, and by classes. Further, the market of each region is then segmented by each therapy to provide a detailed view of the current and future market share of all therapies. 

Large Hemispheric Infarction (LHI) Market Size by Countries

The LHI market size is assessed separately for various countries, including the United States, EU4 (Germany, France, Italy, and Spain), the UK, and Japan. In 2022, the United States held a significant share of the overall 7MM (Seven Major Markets) LHI market, primarily attributed to the country's higher incidence of the condition and the elevated cost of the available treatments. This dominance is projected to persist, especially with the potential early introduction of new products.

Large Hemispheric Infarction (LHI) Market Size by Therapies

Large hemispheric infarction (LHI) Market Size by Therapies is categorized into current and emerging markets for the study period 2020–2034. 

Note: Detailed market segment assessment will be provided in the final report.

Large hemispheric infarction (LHI) Drugs Uptake

This section focuses on the sales uptake of potential LHI drugs that have recently been launched or are anticipated to be launched in the Large hemispheric infarction LHI market between 2020 and 2034. It estimates the market penetration of LHI drugs for a given country, examining their impact within and across classes and segments. It also touches upon the financial and regulatory decisions contributing to the probability of success of the drugs in the LHI market.

The emerging LHI therapies are analyzed based on various attributes such as safety and efficacy in randomized clinical trials, order of entry and other market dynamics, and the unmet need they fulfill in the LHI market.

Note: Detailed assessment of drug uptake and attribute analysis will be provided in the full report on Large hemispheric infarction (LHI).

Large hemispheric infarction (LHI) Market Access and Reimbursement

DelveInsight’s ‘Large hemispheric infarction (LHI) – Market Insights, Epidemiology, and Market Forecast – 2034’ report provides a descriptive overview of the market access and reimbursement scenario of Large hemispheric infarction (LHI).

This section includes a detailed analysis of the country-wise healthcare system for each therapy, enlightening the market access, reimbursement policies, and health technology assessments. 

KOL Views

To keep up with current Large hemispheric infarction (LHI) market trends and fill gaps in secondary findings, we interview KOLs and SMEs working in the Large hemispheric infarction (LHI) domain. Their opinion helps understand and validate current and emerging therapies and treatment patterns or Large hemispheric infarction (LHI) market trends. This will support the clients in potential upcoming novel treatments by identifying the overall scenario of the market and the Large hemispheric infarction (LHI) unmet needs.

Large hemispheric infarction (LHI): KOL Insights

DelveInsight’s analysts connected with 50+ KOLs to gather insights; however, interviews were conducted with 15+ KOLs in the 7MM. These KOLs were from organizations, institutes, and hospitals, such as the Justus Liebig University Giessen (JLU) in Germany, the National Organization for Rare Disorders (NORD), the German Center for Infection Research (DZIF), and organizations like the Large hemispheric infarction (LHI) Research Foundation, among others. 

“Large hemispheric infarction (LHI) is a very severe form of ischemic stroke that affects a significant portion of the middle cerebral artery distribution area, often leading to life-threatening cerebral edema. The high mortality rate and poor functional outcomes which are associated with LHI undermine the need for further research to improve the prediction, management, and outcomes of this devastating condition.”

“The pathophysiology of LHI mainly involves blood-brain barrier breakdown and vasogenic edema formation, contributing to the high mortality rate in patients with severe cerebral edema. Imaging predictors, such as early CT findings and lesion volume assessment, play a crucial role in predicting progression to LHI and malignant cerebral edema.”

Note: Detailed assessment of KOL Views will be provided in the full report on Large hemispheric infarction (LHI).

Competitive Intelligence Analysis

We conduct a competitive and market Intelligence analysis of the Large hemispheric infarction (LHI) Market, utilizing various competitive intelligence tools such as SWOT analysis and market entry strategies. The inclusion of these analyses is contingent upon data availability, ensuring a comprehensive and well-informed assessment of the market landscape and competitive dynamics.

Large hemispheric infarction (LHI) Pipeline Development Activities

The report offers an analysis of therapeutic candidates in Phase II and III stages and examines companies involved in developing targeted therapeutics for Large hemispheric infarction (LHI). It provides valuable insights into the advancements and progress of potential treatments in clinical development for this condition.

Pipeline Development Activities

The report covers information on collaborations, acquisition and merger, licensing, patent details, and other information for emerging Large hemispheric infarction (LHI) therapies.

Large Hemispheric Infarction (LHI) Report Insights

• Large hemispheric infarction Patient Population
• Therapeutic Approaches
• Large Hemispheric Infarction Pipeline Analysis
• Large Hemispheric Infarction Market Size and Trends
• Large hemispheric infarction Market Opportunities
• Impact of Upcoming Therapies

Large Hemispheric Infarction (LHI) Report Key Strengths

• 11 Years Forecast
• The 7MM Coverage
• Large hemispheric infarction Epidemiology Segmentation
• Key Cross Competition
• Highly Analyzed Large Hemispheric Infarction Market
• Large hemispheric infarction Drugs Uptake

Large hemispheric infarction (LHI) Report Assessment

• Large Hemispheric Infarction Current Treatment Practices
• Unmet Needs
• Large hemispheric infarction Pipeline Product Profiles
• Large hemispheric infarction Market Attractiveness

Key Questions

• How common is Large hemispheric infarction?
• What are the key findings of Large hemispheric infarction epidemiology across the 7MM, and which country will have the highest number of patients during the study period (2020–2034)?
• What are the currently available treatments for Large hemispheric infarction?
• What are the disease risks, burden, and unmet needs of Large hemispheric infarction?
• At what CAGR is the Large hemispheric infarction market and its epidemiology is expected to grow in the 7MM during the forecast period (2024–2034)?
• How would the unmet needs impact the Large hemispheric infarction market dynamics and subsequently influence the analysis of the related trends?
• What would be the forecasted patient pool of Large hemispheric infarction in the 7MM covering the United States, EU4 (Germany, France, Italy, and Spain), the UK, and Japan?
• Among EU4 and the UK, which country will have the highest number of patients during the forecast period (2020–2034)?
• How many companies are currently developing therapies for the treatment of Large hemispheric infarction?