Abstract
Patients with acute ischemic stroke may present with minor neurologic deficits. Acute treatment decisions depend on the disability imposed by the symptoms along with radiographic features. The presence of disabling neurologic deficits warrants intravenous thrombolysis, but the indications for endovascular therapy are less defined. The degree of disability, presence of a large vessel occlusion with perfusion mismatch, and collateral circulation status may all be factors in selecting patients for endovascular treatment. Identification of patients who are at risk for neurologic deterioration is critical to preventing poor outcomes in this patient population.
Highlights
Treatment Challenges in Acute Minor Ischemic StrokePatients with acute ischemic stroke may present with minor neurologic deficits
AND CURRENT STATUS OF MINOR ISCHEMIC STROKE TREATMENTClinical trials have shown that acute ischemic stroke can be treated with intravenous (IV) thrombolysis [1, 2] and/or endovascular thrombectomy (ET) [3,4,5]
PRISMS was halted early, but the results suggested that acute ischemic stroke patients with low National Institutes of Health Stroke Scale (NIHSS) scores of 0–5 and no disabling symptoms are unlikely to gain benefit from treatment with alteplase compared to aspirin [15]
Summary
Patients with acute ischemic stroke may present with minor neurologic deficits. Acute treatment decisions depend on the disability imposed by the symptoms along with radiographic features. The presence of disabling neurologic deficits warrants intravenous thrombolysis, but the indications for endovascular therapy are less defined. The degree of disability, presence of a large vessel occlusion with perfusion mismatch, and collateral circulation status may all be factors in selecting patients for endovascular treatment. Identification of patients who are at risk for neurologic deterioration is critical to preventing poor outcomes in this patient population. Reviewed by: Archana Hinduja, The Ohio State University, United States Victor Lopez-Rivera, University of Texas Health Science Center at Houston, United States. Specialty section: This article was submitted to Stroke, a section of the journal Frontiers in Neurology
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