Thrombolysis for mild stroke

Abstract

The term “mild stroke”, or “minor stroke” refers to the acute ischemic stroke patients with mild and nondisabling symptoms. Currently there is still no unanimous consensus on the exact definition of mild stroke. Patients with mild stroke are assumed to have a good prognosis in natural course, so they are routinely not given thrombolysis despite early emergency department arrival. Recent studies have revealed that, however, approximately one third of so-called mild stroke patients who are not treated with thrombolysis have significant disability whereas those treated are more likely to achieve a good recovery. Thus excluding all mild strokes from thrombolysis is probably not justified. Those mild stroke patients who are likely to experience early deterioration or end with disability are mostly characterized by imaging findings. Therefore, selected patients with these characteristics based on neuroimaging to be given thrombolysis might be more justified. Meanwhile, new definition should be developed to exclude those who are at a higher risk of poor outcome. Applying information from imaging may make it come true. Using neuroimaging information to define mild stroke and select patients with mild symptoms to thrombolysis may be a future direction.

Keywords: Definition, Mild stroke, Minor stroke, Neuroimaging, Thrombolysis

Core tip: Clinically, mild stroke patients are routinely excluded from thrombolysis, for the considering that they are too mild and expected to have a good outcome even left untreated. Recent studies showed that mild strokes might also benefit from thrombolysis. However, unlike major stroke, about two thirds of mild stroke patients will have good outcome in nature course; about the one third will end with poor outcomes but they are found to be mostly characterized by imaging features. So we proposed that neuroimaging-based approaches to define mid stroke and selecting mild stroke patients to thrombolysis may be future directions.