Advances and challenges in the acute treatment of minor ischaemic stroke

Although characterised by mild neurological symptoms, typically ranging from 0 to 5 on the National Institutes of Health Stroke Scale (NIHSS), minor ischaemic stroke is associated with frequent long-term disability and a significant risk of stroke recurrence. 1 Smith EE Fonarow GC Reeves MJ et al. Outcomes in mild or rapidly improving stroke not treated with intravenous recombinant tissue-type plasminogen activator: findings from Get With The Guidelines-Stroke. Stroke. 2011; 42: 3110-3115 Crossref PubMed Scopus (175) Google Scholar Research on the treatment of minor stroke has progressed along two parallel paths: acute revascularisation 2 Chen HS Cui Y Zhou ZH et al. Dual antiplatelet therapy vs alteplase for patients with minor nondisabling acute ischemic stroke: the ARAMIS randomized clinical trial. JAMA. 2023; 329: 2135-2234 Crossref PubMed Scopus (20) Google Scholar , 3 Emberson J Lees KR Lyden P et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014; 384: 1929-1935 Summary Full Text Full Text PDF PubMed Scopus (1893) Google Scholar , 4 Khatri P Kleindorfer DO Devlin T et al. Effect of alteplase vs aspirin on functional outcome for patients with acute ischemic stroke and minor nondisabling neurologic deficits: the PRISMS randomized clinical trial. JAMA. 2018; 320: 156-166 Crossref PubMed Scopus (226) Google Scholar and early secondary prevention. 5 Bhatia K Jain V Aggarwal D et al. Dual antiplatelet therapy versus aspirin in patients with stroke or transient ischemic attack: meta-analysis of randomized controlled trials. Stroke. 2021; 52: e217-e223 Crossref PubMed Scopus (31) Google Scholar Navigating these pathways can sometimes lead to complex and confusing decision-making processes. Tenecteplase versus standard of care for minor ischaemic stroke with proven occlusion (TEMPO-2): a randomised, open label, phase 3 superiority trialThere was no benefit and possible harm from treatment with intravenous tenecteplase. Patients with minor stroke and intracranial occlusion should not be routinely treated with intravenous thrombolysis. Full-Text PDF