Intracranial arterial thrombus

A clot in a large intracranial artery, often termed intracranial arterial thrombus or large vessel occlusion, is a pathological blood clot obstructing major cerebral arteries like the middle cerebral artery or internal carotid artery, leading to acute ischemic stroke. It typically arises from atherosclerotic plaque rupture, embolism, or in situ thrombosis, impairing cerebral blood flow and causing infarction with high recurrence risk (7-10% annually in symptomatic stenosis). Biologically, it disrupts normal hemostasis by forming occlusive thrombi that block perfusion, triggering downstream ischemia, neuronal death, and potential hemorrhagic transformation. In disease, it plays a central role in symptomatic intracranial atherosclerotic stenosis (sICAS), with hemodynamic or embolic mechanisms driving recurrent strokes despite medical therapy. Treatments focus on recanalization via intravenous thrombolysis (rt-PA within 4.5 hours), mechanical thrombectomy (e.g., Penumbra system achieving TICI 2a+ recanalization), or aggressive medical management with dual antiplatelets (aspirin + clopidogrel), statins, and blood pressure control, as endovascular stenting shows no benefit and higher periprocedural risks. Anticoagulation bridges to oral agents for select cases, though primarily antiplatelets are favored for arterial pathology. Challenges include poor response in elderly/high-NIHSS patients and balancing reperfusion benefits against hemorrhage risks. Overall, it is managed as a stroke syndrome rather than targeting a specific molecular receptor or enzyme.

Other names

Large artery intracranial thrombusCerebral artery thrombusIntracranial large vessel occlusionThromboembolic occlusion in cerebral artery

Antiplatelet aggregation (aspirin, clopidogrel); Anticoagulation via thrombin inhibition (heparins, VKAs, DOACs); Fibrinolysis (rt-PA); Mechanical thrombectomy (e.g., Penumbra system for clot retrieval); Endovascular recanalization (angioplasty, stenting)