THROMBOTIC STROKE

In thrombotic stroke, a thrombus ( blood clot ) usually forms around atheroscleroticplaques.

Since blockage of the artery is gradual, onset ofsymptomatic thrombotic strokes is slower. A thrombus itself ( even ifnon-occluding ) can lead to an embolic stroke, if the thrombus breaks off, atwhich point it is called an "embolus".

Thrombotic stroke can be divided into two types depending on the type ofvessel the thrombus is formed on :

A. Large vessel disease involves :

• The common and internal carotids
• Vertebral
• The Circle of Willis

Diseases that may form thrombi in the large vesselsinclude :

• Atherosclerosis
• Vasoconstriction ( tightening of the artery )
• Aortic, carotid or vertebral artery dissection
• Various inflammatory diseases of the blood vessel wall, suchas : Takayasu arteritis, Giant cell arteritis, Vasculitis
• Noninflammatory vasculopathy
• Moyamoya disease
• Fibromuscular dysplasia

B. Small vessel disease involves :

• The smaller arteries inside the brain
• Branches of the circle of Willis
• Middle cerebral artery
• Stem
• Arteries arising from the distal vertebral and basilarartery

Diseases that may form thrombi in the small vesselsinclude :

• Lipohyalinosis ( build-up of fatty hyaline matter in theblood vessel as a result of high blood pressure and aging )
• Fibrinoid degeneration ( stroke involving these vessels areknown as lacunar infarcts )
• Microatheroma ( small atherosclerotic plaques )

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