From the Guidelines
An Emergent Large Vessel Occlusion (ELVO) stroke is a severe type of ischemic stroke caused by a blockage in one of the major arteries supplying blood to the brain, typically occurring in vessels such as the internal carotid artery, middle cerebral artery, or basilar artery, and requires immediate medical attention due to its narrow treatment window and potential for significant neurological deficits.
Key Characteristics of ELVO Strokes
- ELVO strokes are particularly dangerous because they affect a large portion of brain tissue and can cause significant neurological deficits including paralysis, speech problems, visual disturbances, and cognitive impairment.
- The standard treatments include intravenous tissue plasminogen activator (tPA) if within 4.5 hours of symptom onset, and mechanical thrombectomy (physical removal of the clot) if within 24 hours for selected patients, as supported by studies such as 1 and 1.
- Time is critical in ELVO strokes, as approximately 1.9 million neurons die each minute the brain lacks blood flow, highlighting the importance of rapid diagnosis and treatment, as emphasized in 1 and 1.
Importance of Rapid Diagnosis and Treatment
- Patients or bystanders should recognize stroke symptoms using the FAST method (Face drooping, Arm weakness, Speech difficulties, Time to call emergency services) and seek immediate emergency care.
- Early identification and rapid transport to a comprehensive stroke center capable of performing thrombectomy significantly improves outcomes and reduces the risk of permanent disability, as noted in 1 and 1.
Diagnostic Approaches
- Imaging techniques such as computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are used to diagnose ELVO strokes and guide treatment decisions, with CTA being more widely used due to its time-efficiency and availability, as discussed in 1.
- The risk/benefit ratio of treatment should be carefully considered, taking into account factors such as the patient's overall health, the severity of the stroke, and the potential risks of treatment, as highlighted in 1 and 1.
From the Research
Definition of ELVO Stroke
- An ELVO (Emergent Large Vessel Occlusion) stroke refers to a type of acute ischemic stroke caused by a blockage in one of the large vessels in the brain 2, 3, 4, 5, 6.
- This condition requires immediate medical attention and is typically treated with endovascular management, including mechanical thrombectomy and intravenous thrombolysis 2, 3, 5.
Characteristics of ELVO Stroke
- ELVO strokes are characterized by a high risk of severe neurologic morbidity and mortality if left untreated or if treatment is delayed 3, 5.
- The condition often requires rapid activation of the neurointerventional team and the use of advanced imaging techniques, such as CT angiography and perfusion imaging, to determine the best course of treatment 3.
- Mechanical thrombectomy, including aspiration and stent retriever techniques, is a common treatment approach for ELVO strokes, with the goal of restoring blood flow to the affected area of the brain 2, 4, 5, 6.
Treatment Approaches
- The treatment of ELVO strokes typically involves a combination of intravenous thrombolysis and mechanical thrombectomy, with the goal of achieving rapid recanalization and reperfusion of the affected vessel 2, 3, 5.
- Aspiration thrombectomy is a technique that involves using a catheter to aspirate the clot, while stent retriever thrombectomy involves using a device to retrieve the clot 4, 6.
- The choice of treatment approach may depend on various factors, including the location and severity of the occlusion, as well as the patient's overall medical condition 3, 5.