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

Takashi Mizowaki; Atsushi Uyama; Atsushi Fujita; Jun Imura; Hiroyasu Shose; Hirotomo Tanaka; Yoshiyuki Takaishi; Takeshi Kondoh

doi:10.4103/ajns.AJNS_554_20

Asian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(04): 881-885
DOI: 10.4103/ajns.AJNS_554_20

Case Report

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

Takashi Mizowaki

Department of Neurosurgery, Shinsuma General Hospital, Suma-Ku, Kobe

,

Atsushi Uyama

¹Department of Neurosurgery, Seisho Hospital, Odawara, Kanagawa

,

Atsushi Fujita

²Department of Neurosurgery, Kobe University Graduate School of Medicine, Kusunoki-Cho, Kobe, Hyogo

,

Jun Imura

Department of Neurosurgery, Shinsuma General Hospital, Suma-Ku, Kobe

,

Hiroyasu Shose

Department of Neurosurgery, Shinsuma General Hospital, Suma-Ku, Kobe

,

Hirotomo Tanaka

Department of Neurosurgery, Shinsuma General Hospital, Suma-Ku, Kobe

,

Yoshiyuki Takaishi

Department of Neurosurgery, Shinsuma General Hospital, Suma-Ku, Kobe

,

Takeshi Kondoh

Department of Neurosurgery, Shinsuma General Hospital, Suma-Ku, Kobe

› Author Affiliations

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.

Key-words:

Acute ischemic stroke - anterior circulation large vessel occlusion - beyond 24 h from stroke onset - endovascular treatment

Full Text

References

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