Management of Acute Stroke Patients With Rapidly Resolving Deficits and Persistent Vascular Occlusion

Abstract

An estimated 8% to 10% of stroke patients arriving at the emergency department within the time window for thrombolysis and with minor or rapidly resolving deficits (RRDs) are found to have proximal arterial occlusions (PAOs).1,2 The management of these patients, particularly when they are neurologically asymptomatic or have only minimal deficits of perceived negligible functional consequence, is challenging because their outcome is unpredictable. Supporters of thrombolysis argue that modern acute ischemic stroke therapy is based on the premise that recanalization and subsequent reperfusion are essential for the preservation of brain tissue and favorable outcomes and that timely thrombolysis is a better option than waiting for clinical deterioration to occur beyond the therapeutic window. Opponents argue that it is impossible to make asymptomatic patients better and cite “ Primum non nocere. ” Drs Kohrmann and Schellinger provide convincing numbers showing that the risk of neurologic deterioration in patients with minor deficits or RRDs far exceeds that of hemorrhagic complications from thrombolysis and …