Acute Treatment of Disabling and Nondisabling Minor Ischemic Stroke: Expert Guidance for Clinicians

Area of Science:

• Neurology
• Cardiology
• Public Health

Background:

• Minor ischemic strokes are common, often underestimated due to mild initial symptoms.
• Despite mild symptoms, up to 30% of patients experience disability within 90 days.
• Current management strategies require refinement for optimal patient outcomes.

Purpose of the Study:

• To provide a pragmatic, scenario-based framework for managing acute minor ischemic stroke.
• To review and synthesize evidence for various therapeutic strategies.
• To guide clinical decision-making based on symptom severity, reperfusion eligibility, and large vessel occlusion.

Main Methods:

• Review of randomized trials, real-world evidence, and international guidelines.
• Analysis of therapeutic strategies including dual antiplatelet therapy, anticoagulation, intravenous thrombolysis, and endovascular treatment.
• Scenario-based approach considering symptom severity and reperfusion status.

Main Results:

• Intravenous thrombolysis is recommended for disabling symptoms within 4.5 hours.
• Dual antiplatelet therapy is standard for noncardioembolic, nondisabling events.
• Early anticoagulation is beneficial for cardioembolic minor stroke ineligible for reperfusion; endovascular treatment evidence is limited.

Conclusions:

• Management of minor ischemic stroke should be individualized based on specific clinical factors.
• Further research is needed, particularly on endovascular treatment for large vessel occlusion in minor stroke.
• This framework aims to optimize acute minor ischemic stroke care and reduce long-term disability.