Large Vessel Stroke

A stroke is caused by a disruption of blood flow or by bleeding in the brain. Some strokes affect a large part of the brain, while others affect a smaller region. Whether a stroke literally affects a large or a small portion of the brain is largely dependent on whether a large blood vessel or a small blood vessel is the cause.

There are large vessel strokes and there are small vessel strokes - and they are very different from each other.

The Arteries in the Brain

Every part of the body, including the brain, has arteries and veins. Arteries bring blood to the brain, while veins carry away blood. The carotid arteries are large arteries on the right side and left side of the neck. Each carotid artery divides and branches out as it climbs up the neck into the skull. Branches of each carotid artery divide into 3 main arteries that supply blood to the brain. These 6 main arteries that feed the brain with oxygen rich and nutrient rich blood are the right and left anterior cerebral arteries, the right and left middle cerebral arteries and the right and left posterior cerebral arteries. These large arteries further divide into smaller and smaller branches as they travel throughout the brain.

What is a Large Vessel Stroke?

A large vessel stroke is a stroke that happens due to interruption of blood flow in one of the main large arteries in the brain.

Because a large vessel stroke happens when a large artery is blocked, all of its smaller branches become blocked too. So a large vessel stroke damages a considerable portion of the brain, typically referred to as the 'vascular territory' of that large blood vessel.

Causes of Large Vessel Strokes

Most of the time, large vessel strokes are caused by blood clots that travel from elsewhere in the body and lodge within an artery in the brain.

These blood clots usually originate in the heart, but can travel from a carotid artery or even from a distant vessel elsewhere in the body.

A blood clot that forms within a blood vessel is called a thrombus, while a traveling blood clot is an embolus. Most large vessel strokes are embolic strokes, meaning that they are caused by blood clots drifting from elsewhere in the body.

An embolus (a traveling blood clot) is generally more likely to get caught in an artery that already has a damaged, irregular inner lining. The inner lining of arteries can become rough and damaged due to hypertension, high blood cholesterol, high levels of fat and triglycerides, smoking and diabetes. Lifestyle factors, particularly drug use, stress, and depression, can also contribute to this type of damage, which is called vascular disease.

Sometimes, a large vessel can develop such a severely damaged inner lining, that a thrombus can form within the large vessel itself. In these less common instances, a large vessel stroke is a thrombotic stroke.

What Happens When Experiencing a Large Vessel Stroke?

Because large arteries in the brain supply a substantial area of the brain, large vessel strokes are literally big. Big strokes can cause serious neurological impairment because they damage a significant portion of the brain, impairing a number of a stroke victim’s physical and mental abilities.

Big strokes also tend to cause swelling in the brain, which can make a stroke much more dangerous in the short term and can slow down recovery.

What to Expect After a Large Vessel Stroke

A middle cerebral artery stroke is one of the most common large vessel strokes. For the most part, the first few days after a large vessel stroke are concerning. Recovery is generally slow and rehabilitation is almost always a necessity after a large vessel stroke.

Long-term stroke recovery includes management of stroke risk factors such as hypertension and heart disease. A central part of stroke recovery also includes prevention of stroke-related complications.

Moving Forward

If you or a loved one has suffered from a large vessel stroke, you may need to adjust to some lifestyle altering consequences of your stroke, such as hemiplegia, muscle stiffness, communication problems, trouble processing spatial relationships, bladder problems and swallowing difficulty. Find out more about that here.

Sources

Prominent Vessel Sign on Susceptibility-Weighted Imaging in Acute Stroke: Prediction of Infarct Growth and Clinical Outcome, Chen CY, Chen CI, Tsai FY, Tsai PH, Chan WP, PLoSOne, June 2015

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