====== Large vessel occlusion outcome ======

Higher [[NIHSS]] scores correlate with more proximal vascular lesions (larger vessel occlusion causes more widespread deficit).

Intracranial [[large vessel occlusion]]s account for a large number of [[acute ischemic stroke]]s and predict poor [[outcome]] after [[stroke]] and in combined groups of [[TIA]] and minor stroke.

Some of the earliest changes in response to ischemic stroke occur in [[blood gas]]es and [[electrolyte]]s. These biochemical changes occur within minutes after occlusion in [[experimental model]]s of [[stroke]] and can be utilized to predict stroke outcomes. 

The majority of ELVO stroke patients are middle-aged to elderly and are of both sexes, revealing that there is an age and sex mismatch between ischemic stroke patients and [[animal model]]s, since most experimental studies use young male [[rat]]s. Rethinking of the animal models should be considered, especially in encouraging the use of aged male and female rats with comorbidities to more closely mirror human populations. [[Mechanical thrombectomy]] provides a unique opportunity for researchers to further this work by expanding the collection and analysis of blood samples that are adjacent to the thrombus. To understand the complexity of stroke, researchers can analyze these tissues for different molecular targets that occur in response to ischemic stroke. This information may aid in the reduction of symptom burden for individuals diagnosed with ischemic stroke. Investigators should also focus on data from ischemic stroke patients and attempt to discover target molecules and then in animal models to establish mechanism, which will aid in the development of new stroke therapies. 

Future studies are needed to identify molecular targets to predict the risk of worsened long-term outcomes and/or increased risk for mortality
((Martha SR, Fraser JF, Pennypacker KR. Acid-Base and Electrolyte Changes Drive 
Early Pathology in Ischemic Stroke. Neuromolecular Med. 2019 Jul 6. doi:
10.1007/s12017-019-08555-5. [Epub ahead of print] Review. PubMed PMID: 31280473.
)).
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Older patients undergoing thrombectomy for emergent large vessel occlusion have worse outcomes. However, complete or near-complete reperfusion (modified Thrombolysis in Cerebral Ischemia (mTICI) score of 2 c/3) is associated with improved outcomes compared with partial recanalisation (mTICI 2b).

Increasing age was associated with worse outcomes for those with partial (mTICI 2b) recanalisation, not in patients with complete (mTICI 2c/3) recanalisation
((Jayaraman MV, Kishkovich T, Baird GL, Hemendinger ML, Tung EL, Yaghi S,
Cutting S, Saad A, Burton TM, Mac Grory B, Haas RA, Furie KL, McTaggart RA.
Association between age and outcomes following thrombectomy for anterior
circulation emergent large vessel occlusion is determined by degree of
recanalisation. J Neurointerv Surg. 2018 Jun 1. pii: neurintsurg-2018-013964.
doi: 10.1136/neurintsurg-2018-013964. [Epub ahead of print] PubMed PMID:
29858396.
)).
----

Although [[tissue plasminogen activator]] and [[endovascular treatment]] were reported to be useful for [[recanalization]] in patients with major vessel occlusion (MVO), the outcome in some patients with recanalization was unfavorable. 

The ipsilateral-PCA sign and low NIHSS score (≤10) were predictors of a favorable outcome in patients with MVO and documented recanalization by treatments
((Yamamoto N, Satomi J, Izumi Y, Yamamoto Y, Yamaguchi I, Furukawa T, Nagahiro
S, Kaji R. Predictors of a Favorable Outcome after Recanalization in Patients
with Cerebral Major Vessel Occlusion. J Stroke Cerebrovasc Dis. 2015 Sep 16. pii:
S1052-3057(15)00442-5. doi: 10.1016/j.jstrokecerebrovasdis.2015.08.012. [Epub
ahead of print] PubMed PMID: 26387040.
)).

===== References =====