Epidemiology, Natural History, and Clinical Presentation of Large Vessel Ischemic Stroke
- PMID: 31197329
- PMCID: PMC6584910
- DOI: 10.1093/neuros/nyz042
Epidemiology, Natural History, and Clinical Presentation of Large Vessel Ischemic Stroke
Abstract
Large vessel occlusions (LVOs), variably defined as blockages of the proximal intracranial anterior and posterior circulation, account for approximately 24% to 46% of acute ischemic strokes. Commonly refractory to intravenous tissue plasminogen activator (tPA), LVOs place large cerebral territories at ischemic risk and cause high rates of morbidity and mortality without further treatment. Over the past few years, an abundance of high-quality data has demonstrated the efficacy of endovascular thrombectomy for improving clinical outcomes in patients with LVOs, transforming the treatment algorithm for affected patients. In this review, we discuss the epidemiology, pathophysiology, natural history, and clinical presentation of LVOs as a framework for understanding the recent clinical strides of the endovascular era.
Keywords: Endovascular thrombectomy; Large vessel occlusion; Stroke.
© Congress of Neurological Surgeons 2019.
Similar articles
-
A population-based incidence of acute large vessel occlusions and thrombectomy eligible patients indicates significant potential for growth of endovascular stroke therapy in the USA.J Neurointerv Surg. 2017 Aug;9(8):722-726. doi: 10.1136/neurintsurg-2016-012515. Epub 2016 Jul 15. J Neurointerv Surg. 2017. PMID: 27422968 Free PMC article.
-
Endovascular Thrombectomy for Mild Strokes: How Low Should We Go?Stroke. 2018 Oct;49(10):2398-2405. doi: 10.1161/STROKEAHA.118.022114. Stroke. 2018. PMID: 30355094 Free PMC article.
-
Beyond Large Vessel Occlusion Strokes: Distal Occlusion Thrombectomy.Stroke. 2018 Jul;49(7):1662-1668. doi: 10.1161/STROKEAHA.118.020567. Epub 2018 Jun 18. Stroke. 2018. PMID: 29915125
-
Endovascular intracranial treatment of acute ischemic strokes.J Cardiovasc Surg (Torino). 2016 Feb;57(1):36-47. J Cardiovasc Surg (Torino). 2016. PMID: 26771725 Review.
-
Mechanical thrombectomy - is time still brain? The DAWN of a new era.Br J Neurosurg. 2018 Jun;32(3):245-249. doi: 10.1080/02688697.2018.1426726. Epub 2018 Feb 8. Br J Neurosurg. 2018. PMID: 29417839 Review.
Cited by
-
Direct mechanical thrombectomy versus bridging therapy in acute ischemic stroke: A systematic review and meta-analysis of randomized clinical trials.World Neurosurg X. 2023 Dec 9;21:100250. doi: 10.1016/j.wnsx.2023.100250. eCollection 2024 Jan. World Neurosurg X. 2023. PMID: 38173685 Free PMC article. Review. No abstract available.
-
Use of biplane quantitative angiographic imaging with ensemble neural networks to assess reperfusion status during mechanical thrombectomy.Proc SPIE Int Soc Opt Eng. 2021 Feb;11597:115971F. doi: 10.1117/12.2580358. Epub 2021 Feb 15. Proc SPIE Int Soc Opt Eng. 2021. PMID: 33707812 Free PMC article.
-
The impact of large core and late treatment trials: An update on the modelled annual thrombectomy eligibility of UK stroke patients.Eur Stroke J. 2024 Sep;9(3):566-574. doi: 10.1177/23969873241232820. Epub 2024 Feb 17. Eur Stroke J. 2024. PMID: 38366958 Free PMC article.
-
A novel emergency medical services protocol to improve treatment time for large vessel occlusion strokes.PLoS One. 2022 Feb 25;17(2):e0264539. doi: 10.1371/journal.pone.0264539. eCollection 2022. PLoS One. 2022. PMID: 35213646 Free PMC article.
-
Ischemic Stroke at a Tertiary Academic Hospital in Tanzania: A Prospective Cohort Study With a Focus on Presumed Large Vessel Occlusion.Front Neurol. 2022 Jul 14;13:882928. doi: 10.3389/fneur.2022.882928. eCollection 2022. Front Neurol. 2022. PMID: 35911912 Free PMC article.
References
-
- Dozois A, Hampton L, Kingston CW et al. .. PLUMBER study (prevalence of large vessel occlusion strokes in Mecklenburg county emergency response). Stroke. 2017;48(12):3397-3399. - PubMed
-
- Berkhemer OA, Fransen PS, Beumer D et al. .. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372(1):11-20. PMID: 25517348 - PubMed
MeSH terms
LinkOut - more resources
Full Text Sources
Medical
Miscellaneous