Large vessel occlusion stroke due to underlying intracranial atherosclerotic disease (ICAD-LVO) is prevalent in 10 to 30% of LVOs depending on patient factors such as vascular risk factors, race and ethnicity, and age. Patients with ICAD-LVO derive similar functional outcome benefit from endovascular thrombectomy as other mechanisms of LVO, but up to half of ICAD-LVO patients reocclude after revascularization. Therefore, early identification and treatment planning for ICAD-LVO are important given the unique considerations before, during, and after endovascular thrombectomy. In this review of ICAD-LVO, we propose a multistep approach to ICAD-LVO identification, pretreatment and endovascular thrombectomy considerations, adjunctive medications, and medical management. There have been no large-scale randomized controlled trials dedicated to studying ICAD-LVO, therefore this review focuses on observational studies.
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http://dx.doi.org/10.1161/STROKEAHA.122.040008 | DOI Listing |
J Clin Neurosci
December 2024
Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan; Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
Re-occlusion and intravascular thrombus formation following mechanical thrombectomy (MT) in stroke patients worsen clinical outcomes. Although early administration of antiplatelet therapy (APT) prevents these complications, current guidelines advise against using APT soon after intravenous thrombolysis (IVT), making the management of atherothrombotic large vessel occlusion (AT-LVO) difficult. We investigated the safety of early APT for acute AT-LVO treated with MT following IVT.
View Article and Find Full Text PDFRadiol Case Rep
February 2025
Department of Endovascular Surgery, State Budgetary Healthcare Institution "City Clinical Hospital named after M.E. Zhadkevich", Mozhaiskoe Highway, 14 121374, Moscow, Russia.
This case report presents a clinical case of management of a patient with concomitant ischemic stroke and acute arterial ischemia of the right upper limb. Emergency thrombaspiration from the middle cerebral artery improved the patient's neurological status. A hybrid intervention was carried out to restore blood flow in the right upper limb: brachial artery arteriotomy with thrombectomy through an open approach combined with endovascular recanalisation and balloon angioplasty of the forearm arteries.
View Article and Find Full Text PDFCardiol Cardiovasc Med
December 2024
Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona CA 91766, USA.
Universally, stroke presents as neurological deficits due to the obstruction of blood supply to specific regions of the brain. Among the three main categories of stroke, acute ischemic stroke is the leading cause of death and disability worldwide. As of today, there are two effective treatment methods: thrombolysis and endovascular therapy.
View Article and Find Full Text PDFCatheter Cardiovasc Interv
December 2024
Division of Cardiovascular Medicine, New York University, New York, New York, USA.
Background: The recently published PEERLESS trial compared catheter-directed thrombolysis (CDT) and catheter-based thrombectomy (CBT) in acute pulmonary embolism (PE). However, it included a low proportion of patients with contraindications to thrombolytic therapy (4.4%), leaving uncertainty about how CDT would perform relative to CBT in a real-world cohort with higher bleeding risk.
View Article and Find Full Text PDFInt J Stroke
December 2024
PN Sylaja, DM, Professor and Head of Neurology, SCTIMST, Thiruvananthapuram, Kerala, India.
Background: Stroke is a leading cause of global mortality and disability, with a disproportionately high burden in low- and middle-income countries. Access to intravenous thrombolysis (IVT) and endovascular treatment (EVT) remains extremely limited.
Aims: We evaluated the spatial distribution and geographic accessibility of stroke centers in India.
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