SUMMARY: In this review, we examined recent epidemiological features of ischaemic stroke and intracerebral haemorrhage in Asia with recent developments in hyperacute stroke reperfusion therapy and technical improvements in intracerebral haemorrhage. The article also discussed the spectrum of cerebrovascular diseases in Asia, which include intracranial atherosclerosis, intracerebral haemorrhage, infective aetiologies of stroke, moyamoya disease, vascular dissection, radiation vasculopathy, and cerebral venous thrombosis.

CASE PRESENTATION: This case highlights the diagnostic and acute treatment challenges in BAO due to its non-specific symptoms and emphasizes the critical role of CT angiography in detecting occlusive thrombi for timely intervention. With prompt endovascular thrombectomy and bridging intravenous thrombolysis, complete recanalization was achieved and the patient was discharged with modified Rankin Scale (mRS) of 1. Effective management strategies involve assessing ventricular function, detecting arrhythmias, identifying intracardiac thrombi, and implementing individualized stroke prevention measures, such as using direct oral anticoagulants.

CONCLUSION: This study illustrates the necessity of a multidisciplinary approach in optimizing patient outcomes in acute stroke care. Focusing on the rare condition of ARVC and the specific challenge of top-of-BAOs in this case underscores the intricate interplay between cardiovascular and cerebrovascular pathology leading to improved understanding and management of these conditions.

INTRODUCTION: This case report illustrates the complexities of arrhythmogenic right ventricular cardiomyopathy (ARVC) and its thromboembolic complications resulting in top-of-basilar artery syndrome. We discuss the case of a 37-year-old male with ARVC who presented with acute onset of dizziness, imbalance, and vomiting, leading to the diagnosis of a top-of-basilar artery occlusion (BAO) which was successfully treated.

CASE PRESENTATION: This case highlights the diagnostic and acute treatment challenges in BAO due to its non-specific symptoms and emphasizes the critical role of CT angiography in detecting occlusive thrombi for timely intervention. With prompt endovascular thrombectomy and bridging intravenous thrombolysis, complete recanalization was achieved and the patient was discharged with modified Rankin Scale (mRS) of 1. Effective management strategies involve assessing ventricular function, detecting arrhythmias, identifying intracardiac thrombi, and implementing individualized stroke prevention measures, such as using direct oral anticoagulants.

METHODS: This is an international, multicenter, observational, prospective cohort study of patients admitted with acute ischemic stroke secondary to ICAS to stroke centers in six Asian countries. Stroke due to ICAS was diagnosed when there was a ≥50% intracranial large artery stenosis ipslateral to a non-lacunar infarct, without significant ipsilateral extracranial stenosis, cardiac cause or other mechanism found for the stroke. Data were collected on patient demographics, vascular risk factors, stroke location, and severity. Outcomes of interest were stroke recurrence and mortality at 12-month follow-up.

RESULTS: A total of 356 patients were recruited. Mean age was 62.7 ± 13.8 years, and 39.9% were females. Mean NIHSS on admission was 9 ± 8, with majority of patients having mild (39.3%) or moderate (37.9%) strokes. Stroke recurrence was 6.7% (95% CI: 4.4-9.9%) while mortality rate was 13.2% (95% CI: 9.9-17.2%) within 1 year. The risk of stroke recurrence was associated with increasing age (odds ratio [OR]: 1.04, 95% CI: 1-1.06, p = 0.05) and hypertension (OR: 3.23, 95% CI: 1.09-9.61, p = 0.035). Mortality was associated with age (OR: 1.05, 95% CI: 1.01-1.08, p = 0.006) and NIHSS (OR: 1.12, 95% CI: 1.07-1.17, p < 0.001).