医学
阿司匹林
溶栓
轻微中风
抗血栓
冲程(发动机)
重症监护医学
纤溶剂
缺血性中风
血小板聚集抑制剂
急性中风
随机对照试验
物理疗法
急诊医学
辅修(学术)
梅德林
缺血
闭塞
血管内治疗
血管疾病
外科
氯吡格雷
改良兰金量表
脑缺血
急性冠脉综合征
临床试验
疾病严重程度
P2Y12
作者
Federico De Santis,Matteo Foschi,Lucio D’Anna,Shelagh B. Coutts,Urs Fischer,Pooja Khatri,Ahmed Nasreldein,Octávio Marques Pontes‐Neto,Thanh N. Nguyen,Else Charlotte Sandset,Georgios Tsivgoulis,Guillaume Turc,Simona Sacco
出处
期刊:Stroke
[Lippincott Williams & Wilkins]
日期:2025-12-11
卷期号:57 (2): 549-559
被引量:2
标识
DOI:10.1161/strokeaha.125.053504
摘要
Minor ischemic strokes, usually defined as acute ischemic strokes with National Institutes of Health Stroke Scale score ≤5, account for over half of all cases and are often underestimated due to initially mild symptoms. Yet up to 30% of patients develop disability within 90 days, challenging the notion of a benign course. This guidance offers a pragmatic, scenario-based framework for acute minor ischemic stroke management, considering symptom severity (disabling versus nondisabling), eligibility for reperfusion, and presence of large vessel occlusion. Drawing from randomized trials, real-world evidence, and international guidelines, we examine therapeutic strategies, including dual antiplatelet therapy with aspirin plus a P2Y12 inhibitor, anticoagulation, intravenous thrombolysis, and endovascular treatment. Intravenous thrombolysis is preferred for disabling symptoms within 4.5 hours of symptom onset, whereas dual antiplatelet therapy remains standard for noncardioembolic, nondisabling events. For cardioembolic minor ischemic stroke ineligible for reperfusion, early anticoagulation within 48 hours appears safe and beneficial. Evidence for routine endovascular treatment in minor ischemic stroke with large vessel occlusion remains limited and controversial. We also address management of rapidly improving yet disabling symptoms and postreperfusion antithrombotic strategies, emphasizing individualized care and the need for further research.
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