Thrombotic Strokes
In this chapter, we will describe the management strategy in the large artery extracranial atherosclerotic disease of the neck, dissection of the extracranial arteries of the head and neck, as well as small vessel disease. The main mechanism of stroke in patients who have extracranial atherosclerosis and/or dissection is artery-to-artery embolism, occasionally associated with hemodynamic disturbances. Although these mechanisms are also important in patients with intracranial atherosclerosis, branch occlusion and in situ thrombotic occlusion play a relatively more important role in these patients. Small vessel disease/cerebral small vessel disease describes pathology due to occlusion or stenosis of small, penetrating arteries of the brain. We discuss the pathophysiology, clinical presentations, diagnostic workups, and current treatment recommendations. Any treatment strategy should be based on the correct understanding of the stroke mechanism in individual patients.
