Podcast 849: Large Vessel Occlusions

<p dir="ltr"><strong>Contributor:</strong> Travis Barlock MD</p> <p dir="ltr"><strong>Educational Pearls:</strong> </p> <p dir="ltr">Large Vessel Occlusion (LVO) is a condition where a clot blocks one of the major blood vessels in the brain, leading to a stroke.</p> <p dir="ltr"><strong>What are the vessels that can experience an LVO?</strong></p> <p dir="ltr">Middle Cerebral artery (MCA)</p> <p dir="ltr">Internal Carotid Artery (ICA)</p> <p dir="ltr">Anterior Cerebral Artery (ACA)</p> <p dir="ltr">Posterior Cerebral Arteries (PCA)</p> <p dir="ltr">Basilar Artery (BA)</p> <p dir="ltr">Vertebral Arteries (VA)</p> <p dir="ltr"><strong>What are the locations at which a mechanical thrombectomy can be performed as a treatment for an LVO?</strong></p> <p dir="ltr">Distal ICA, M1 or M2 segments of the MCA, A1 or A2 segments of the ACA, and some evidence for the BA.</p> <p dir="ltr">What are the symptoms of LVO?</p> <p dir="ltr"><strong>Use the mnemonic FANG-D to remember a few key symptoms:</strong></p> <p dir="ltr">Field Cut (A person loses vision in a portion of their visual field)</p> <p dir="ltr">Aphasia (Difficulty speaking)</p> <p dir="ltr">Neglect (A person may have difficulty paying attention to or acknowledging stimuli on the affected side of their body or in their environment. For example, a person with neglect may deny that their left hand belongs to them)</p> <p dir="ltr">Gaze Deviation (One or both eyes are turned away from the direction of gaze)</p> <p dir="ltr">Dense Hemiparesis (Paralysis affecting one side of the body)</p> <p dir="ltr">What are the treatment windows for treating an LVO?</p> <p dir="ltr">24 hours for mechanical thrombectomy</p> <p dir="ltr">0-4.5 hours for tPA/TNK</p> <p dir="ltr"><strong>References</strong></p> <p dir="ltr">1. Brain embolism, Caplan LR, Manning W (Eds), Informa Healthcare, New York 2006.</p> <p dir="ltr">2. Berkhemer OA, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015 Jan 1;372(1):11-20. doi: 10.1056/NEJMoa1411587. Epub