Distal Medium Vessel Occlusion Strokes: Understanding the Present and Paving the Way for a Better Future

 

But you tell us NOTHING ON 100% RECOVERY RESULTS!  The only goal in stroke, I guess that won't be important to you until you are the 1 in 4 per WHO that has a stroke Might be too late then for you to solve the 100% problem!

So no reporting or measurement of 100% recovery, obviously not important to the medical staff or researchers. But vastly important to stroke survivors. 

“What's measured, improves.” So said management legend and author Peter F. Drucker 

You'll want 100% recovery when you are the 1 in 4 per WHO that has a stroke! Explain how you're going to get to 100% recovery if you don't start that research RIGHT NOW!

Distal Medium Vessel Occlusion Strokes: Understanding the Present and Paving the Way for a Better Future

J Stroke. 2024;26(2):190-202

Publication date (electronic) : 2024 May 30

doi : https://doi.org/10.5853/jos.2023.02649

Raul G. Nogueira^,1, Mohamed F. Doheim¹, Alhamza R. Al-Bayati¹, Jin Soo Lee², Diogo C. Haussen³, Mahmoud Mohammaden³, Michael Lang⁴, Matthew Starr¹, Marcelo Rocha¹, Catarina Perry da Câmara⁵, Bradley A. Gross⁴, Nirav R. Bhatt¹

¹UPMC Stroke Institute, Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

²Department of Neurology, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Korea

³Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA

⁴UPMC Stroke Institute, Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

⁵Department of Neuroradiology, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal

Correspondence: Raul G. Nogueira University of Pittsburgh Medical Center Stroke Institute, 200 Lothrop Street, C-400 PUH, Pittsburgh, PA 15213, USA Tel: +1-412-647-8080 Email: raul.g.nogueira@icloud.com

Received 2023 August 12; Revised 2024 February 2; Accepted 2024 February 6.

Abstract

Distal medium vessel occlusions (DMVOs) are thought to cause as many as 25% to 40% of all acute ischemic strokes and may result in substantial disability amongst survivors. Although intravenous thrombolysis (IVT) is more effective for distal than proximal vessel occlusions, the overall efficacy of IVT remains limited in DMVO with less than 50% of patients achieving reperfusion and about 1/3 to 1/4 of the patients failing to achieve functional independence. Data regarding mechanical thrombectomy (MT) among these patients remains limited. The smaller, thinner, and more tortuous vessels involved in DMVO are presumably associated with higher procedural risks whereas a lower benefit might be expected given the smaller amount of tissue territory at risk. Recent advances in technology have shown promising results in endovascular treatment of DMVOs with room for future improvement. In this review, we discuss some of the key technical and clinical considerations in DMVO treatment including the anatomical and clinical terminology, diagnostic modalities, the role of IVT and MT, existing technology, and technical challenges as well as the contemporary evidence and future treatment directions.