How do large-vessel occlusion strokes differ in management from lacunar strokes?

• A. Lacunar strokes require mechanical thrombectomy
• B. LVO strokes are treated medically with antiplatelets only
• C. LVO strokes may be eligible for mechanical thrombectomy and urgent reperfusion; lacunar strokes managed medically
• D. Both require corticosteroids

Answer: (C)

The key idea is that the size and location of the blocked vessel determine the best treatment approach. Large-vessel occlusion strokes involve major intracranial arteries, so removing the clot quickly with mechanical thrombectomy to restore blood flow can substantially reduce brain damage. This urgent reperfusion option is often pursued in eligible patients. Lacunar strokes come from disease of small penetrating arteries, producing small, deep infarcts, and there isn’t a large clot to retrieve. The emphasis instead is medical management: antiplatelet therapy, strict control of risk factors, and secondary prevention to reduce future risk. Corticosteroids are not standard therapy for acute ischemic stroke and don’t improve outcomes, so they aren’t part of the distinguishing management strategies.