Understanding of pathophysiology and optimal treatment for anterior circulation large vessel occlusion beyond 24 h from onset of stroke

Abstract

We report three cases in which endovascular treatment (EVT) was performed for anterior circulation large vessel occlusion (LVO) beyond 24 h from the onset of stroke. Case 1 experienced left hemispatial neglect and gait disorder due to right internal cerebral artery (ICA) occlusion and underlying atherosclerosis. After percutaneous transluminal angioplasty (PTA), revascularization with mild stenosis was achieved. Case 2 complained of reduced activity, motor aphasia, and right-sided hemiparesis due to left middle cerebral artery occlusion. After thrombectomy using a retrieval stent, revascularization with M1 stenosis and distal perfusion delay was observed, which improved after PTA. Case 3 arrived at our hospital 30 h after the onset of dysarthria and gait disturbance due to left ICA occlusion. Since the symptoms were mild, medical treatment was started; however, the patient's symptoms deteriorated 6 h later, and EVT was required. After thrombectomy using a retrieval stent, revascularization was achieved. LVO pathophysiology beyond 24 h of stroke onset varies and may require multimodal treatment. Preserving the pyramidal tract may lead to favorable outcomes, even in cases of anterior circulation LVO. EVT may be effective for anterior circulation LVO because, in some patients, infarct volume continues to increase >24 h after stroke onset.

Endovascular Treatment plus Medical Treatment versus Medical Treatment Alone in Ischemic Stroke: A Systematic Review and Meta-Analysis

“…On the other hand, other vessel occlusions had contradictory results compared to the main analysis in terms of efficacy but similar effects in terms of safety. The difference between LVO and other vessel occlusion in terms of outcomes that we observed in our study was consistent with the existing literature [50,51]. This may be due to the presence of multiple collaterals and the slow progression of a large vessel stroke allowing an adequate development of collateral circulation to that area before the onset of acute ischemic stroke [52,53].…”

Predicting haemorrhagic transformation through serum biochemical indices for patients after endovascular treatment: a retrospective study

“…The pathophysiology of ACLVO is mainly the obstruction of blood vessels, leading to local ischaemia and hypoxia of brain tissue, which can cause a series of physiological reactions such as brain cell death, brain oedema, and inflammatory response. These reactions can cause neurological dysfunction and damage to the nervous system, thereby affecting the patient's quality of life and prognosis [9].…”