Department of Neurosurgery, University of California-San Diego, La Jolla, California.
Neurosurgery. 2019 Jul 1;85(suppl_1):S4-S8. doi: 10.1093/neuros/nyz042.
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.
大血管闭塞（LVOs）通常定义为近端颅内前循环和后循环的阻塞，占急性缺血性脑卒中的 24%至 46%。LVOs 通常对静脉注射组织型纤溶酶原激活剂（tPA）有抵抗力，会使大面积的大脑区域面临缺血风险，并导致高发病率和死亡率，如果不进行进一步治疗的话。在过去的几年中，大量高质量的数据已经证明了血管内血栓切除术在改善 LVOs 患者临床转归方面的有效性，改变了受影响患者的治疗方案。在这篇综述中，我们讨论了 LVOs 的流行病学、病理生理学、自然史和临床表现，以此作为理解血管内时代最近临床进展的框架。
