Treatment Options for Cerebrovascular Occlusion

Acute Treatment for Cerebrovascular Occlusion

During the acute phase of cerebrovascular occlusion, the only effective treatments for restoring blood flow are thrombolytic therapy and mechanical thrombectomy. These interventions are time-sensitive and must be administered within specific treatment windows. For anterior circulation strokes, the window for intravenous thrombolysis is typically up to 3 hours after symptom onset, while for posterior circulation strokes, this window extends to 4.5 hours. Mechanical thrombectomy, on the other hand, can be performed within a 16-hour window from symptom onset, provided imaging confirms the presence of a large vessel occlusion and salvageable brain tissue.

Timely arrival at a medical facility is crucial to ensure accurate diagnosis and prompt treatment. When performed within the appropriate time frame, these procedures not only improve the chances of reperfusion but also reduce the risk of hemorrhagic complications. Early intervention significantly increases the likelihood of a better functional outcome and lower mortality rates.

Secondary Prevention After the Acute Phase

Once the acute phase has passed, the focus shifts to secondary prevention strategies aimed at reducing the risk of future cerebrovascular events. This includes antiplatelet therapy, lipid-lowering treatment, blood pressure control, diabetes management, and lifestyle modifications.

For patients without significant intracranial large vessel stenosis, dual antiplatelet therapy (aspirin and clopidogrel) is typically recommended for three weeks, after which monotherapy with either agent is continued. However, if there is evidence of major vessel narrowing within the cranium, dual antiplatelet therapy should be maintained for up to three months to prevent recurrent strokes.

Lipid Management and Statin Use

Statin therapy plays a critical role in stroke prevention by lowering low-density lipoprotein (LDL) cholesterol levels. The target is to achieve an LDL level below 1.8 mmol/L or a reduction of at least 50% from baseline. Maintaining optimal lipid levels helps stabilize atherosclerotic plaques and reduce the risk of further vascular events.

Blood Pressure Control

In the acute phase, blood pressure may rise temporarily due to stress responses or neurological reflexes. In most cases, aggressive blood pressure lowering is not required unless there are coexisting life-threatening conditions such as heart failure. Once the patient's hemodynamic status stabilizes—usually within 2 to 3 days—antihypertensive therapy can be initiated gradually. The goal is to reduce blood pressure to below 140/80 mmHg over a period of 1 to 2 weeks to minimize the risk of future strokes.

Diabetes Management and Lifestyle Adjustments

For patients with diabetes, strict glycemic control is essential to reduce the risk of microvascular and macrovascular complications. In addition to pharmacologic interventions, lifestyle changes are a cornerstone of long-term vascular health. Smoking cessation and alcohol moderation are strongly advised, as both are significant risk factors for recurrent stroke.

Regular physical activity also plays a vital role in recovery and prevention. Adults are encouraged to engage in at least 30 to 60 minutes of moderate-intensity aerobic exercise daily. Exercise helps improve cardiovascular fitness, control weight, and enhance overall brain health, contributing to a lower risk of future cerebrovascular incidents.