Department of Clinical Neurosciences (M.G., M.K., J.M.O.), University of Calgary, Canada.
Department of Radiology (M.G.), University of Calgary, Canada.
Stroke. 2021 Mar;52(3):1147-1153. doi: 10.1161/STROKEAHA.120.032799. Epub 2021 Jan 20.
Medium vessel occlusions (MeVOs, ie, M2, M3, A2, A3, P2, and P3 segment occlusions) are increasingly recognized as a target for endovascular treatment in acute ischemic stroke. It is important to note that not all MeVOs are equal. Primary MeVOs occur de novo with the underlying mechanisms being very similar to large vessel occlusion strokes. Secondary MeVOs arise from large vessel occlusions through clot migration or fragmentation, either spontaneously or following treatment with intravenous thrombolysis or endovascular treatment. Currently, there are little data on the prevalence, management, and prognosis of acute ischemic stroke due to secondary MeVOs. This type of stroke is, however, likely to become more relevant in the future as indications for endovascular treatment continue to broaden. In this article, we describe different types of secondary MeVOs, imaging findings associated with them, challenges related to the diagnosis of secondary MeVOs, and their potential implications for treatment strategies and clinical outcomes.
中等大小血管闭塞（MeVOs，即 M2、M3、A2、A3、P2 和 P3 段闭塞）越来越被认为是急性缺血性卒中血管内治疗的目标。需要注意的是，并非所有的 MeVOs 都是相同的。原发性 MeVOs 是新发的，其潜在机制与大血管闭塞性卒中非常相似。继发性 MeVOs 是由于大血管闭塞，通过栓子迁移或碎裂引起的，无论是自发性的还是在静脉溶栓或血管内治疗后发生的。目前，关于继发于 MeVOs 的急性缺血性卒中的患病率、管理和预后的数据很少。然而，随着血管内治疗适应证的不断扩大，这种类型的卒中在未来可能会变得更加相关。本文描述了不同类型的继发 MeVOs、与其相关的影像学表现、继发 MeVOs 诊断相关的挑战及其对治疗策略和临床结局的潜在影响。
