{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T09:29:15Z","timestamp":1791538155949,"version":"4.3.4"},"reference-count":113,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:p>Minor ischemic strokes, usually defined as acute ischemic strokes with National Institutes of Health Stroke Scale score \u22645, 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.<\/jats:p>","DOI":"10.1161\/strokeaha.125.053504","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T10:00:18Z","timestamp":1765447218000},"page":"549-559","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Acute Treatment of Disabling and Nondisabling Minor Ischemic Stroke: Expert Guidance for Clinicians"],"prefix":"10.1161","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8059-6427","authenticated-orcid":true,"given":"Federico","family":"De Santis","sequence":"first","affiliation":[{"name":"Department of Biotechnological and Applied Clinical Sciences, University of L\u2019Aquila, Italy (F.D.S., M.F., S.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0321-7155","authenticated-orcid":true,"given":"Matteo","family":"Foschi","sequence":"additional","affiliation":[{"name":"Department of Biotechnological and Applied Clinical Sciences, University of L\u2019Aquila, Italy (F.D.S., M.F., S.S.)."},{"name":"Department of Neuroscience, Neurology Unit\u2013Stroke Unit, S. Maria delle Croci Hospital, Azienda Unit\u00e0 Sanitaria Locale (AUSL) Romagna, Ravenna, Italy (M.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4349-3322","authenticated-orcid":true,"given":"Lucio","family":"D\u2019Anna","sequence":"additional","affiliation":[{"name":"Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London, National Health System (NHS) Healthcare Trust, United Kingdom (L.D.)."},{"name":"Department of Brain Sciences, Imperial College London, United Kingdom (L.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5090-5105","authenticated-orcid":true,"given":"Shelagh B.","family":"Coutts","sequence":"additional","affiliation":[{"name":"Departments of Clinical Neurosciences, Radiology and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (S.B.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0521-4051","authenticated-orcid":true,"given":"Urs","family":"Fischer","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital Bern, University of Bern, Switzerland (U.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7344-8266","authenticated-orcid":true,"given":"Pooja","family":"Khatri","sequence":"additional","affiliation":[{"name":"Department of Neurology, Yale University, New Haven, CT (P.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2734-233X","authenticated-orcid":true,"given":"Ahmed","family":"Nasreldein","sequence":"additional","affiliation":[{"name":"Department of Neurology, Assiut University Hospitals, Assiut University, Egypt (A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0317-843X","authenticated-orcid":true,"given":"Oct\u00e1vio Marques","family":"Pontes-Neto","sequence":"additional","affiliation":[{"name":"Neurology Division, Department of Neurosciences and Behavioral Sciences, Ribeir\u00e3o Preto Medical School, University of S\u00e3o Paulo, Brazil (O.M.P.-N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2810-1685","authenticated-orcid":true,"given":"Thanh N.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Neurology Division, Radiology Division, Boston Medical Center, MA (T.N.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Else Charlotte","family":"Sandset","sequence":"additional","affiliation":[{"name":"Department of Neurology, Oslo University Hospital, Norway (E.C.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0640-3797","authenticated-orcid":true,"given":"Georgios","family":"Tsivgoulis","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, \u201cAttikon\u201d University Hospital, Greece (G. Tsivgoulis)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5059-4095","authenticated-orcid":true,"given":"Guillaume","family":"Turc","sequence":"additional","affiliation":[{"name":"Department of Neurology, Group Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Universit\u00e9 Paris Cit\u00e9, France (G. Turc)."},{"name":"Institute of Psychiatry and Neuroscience of Paris, Institut National de la Sanit\u00e9 et de la Recherche M\u00e9dicale (INSERM) U1266, France (G. Turc)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0651-1939","authenticated-orcid":true,"given":"Simona","family":"Sacco","sequence":"additional","affiliation":[{"name":"Department of Biotechnological and Applied Clinical Sciences, University of L\u2019Aquila, Italy (F.D.S., M.F., S.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.113.002881"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.549576"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.032809"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.113.001584"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1603060"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1916870"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)00921-8"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2023-079061"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2024.4688"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.572883"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1215340"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1800410"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-022-03442-8"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.119.006474"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.119.027569"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.113.000878"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.7827"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/23969873211000877"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000375"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.000604"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1159\/000368886"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1177\/2396987317746003"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.637421"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2020.4557"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-017-8490-3"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.114.005426"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000012661"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.20.8.983"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.29.10.2118"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.284.22.2901"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000110311.09970.83"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(07)70274-0"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.167.22.2417"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1412981"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.028992"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2021.105935"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1802712"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.613208"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.26.8.1358"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.8496"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.123.045495"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1411587"},{"key":"e_1_3_2_44_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1503780"},{"key":"e_1_3_2_45_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1415061"},{"key":"e_1_3_2_46_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60584-5"},{"key":"e_1_3_2_47_2","doi-asserted-by":"publisher","DOI":"10.1177\/2396987321989865"},{"key":"e_1_3_2_48_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000211"},{"key":"e_1_3_2_49_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.107.505438"},{"key":"e_1_3_2_50_2","doi-asserted-by":"publisher","DOI":"10.1159\/000352060"},{"key":"e_1_3_2_51_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.107.488833"},{"key":"e_1_3_2_52_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13311-023-01391-3"},{"key":"e_1_3_2_53_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.572040"},{"key":"e_1_3_2_54_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(15)70017-7"},{"key":"e_1_3_2_55_2","doi-asserted-by":"publisher","DOI":"10.1136\/svn-2021-000978"},{"key":"e_1_3_2_56_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)01054-6"},{"key":"e_1_3_2_57_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)02600-9"},{"key":"e_1_3_2_58_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(17)30253-3"},{"key":"e_1_3_2_59_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(24)00206-0"},{"key":"e_1_3_2_60_2","doi-asserted-by":"publisher","DOI":"10.1177\/23969873221150022"},{"key":"e_1_3_2_61_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000209903"},{"key":"e_1_3_2_62_2","doi-asserted-by":"publisher","DOI":"10.1177\/17562864231221324"},{"key":"e_1_3_2_63_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1813046"},{"key":"e_1_3_2_64_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2413344"},{"key":"e_1_3_2_65_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(07)70250-8"},{"key":"e_1_3_2_66_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.033033"},{"key":"e_1_3_2_67_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2309137"},{"key":"e_1_3_2_68_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.122.041660"},{"key":"e_1_3_2_69_2","doi-asserted-by":"publisher","DOI":"10.1177\/23969873241255250"},{"key":"e_1_3_2_70_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.8662"},{"key":"e_1_3_2_71_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.024913"},{"key":"e_1_3_2_72_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2111749"},{"key":"e_1_3_2_73_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.11735"},{"key":"e_1_3_2_74_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.122.060666"},{"key":"e_1_3_2_75_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2303048"},{"key":"e_1_3_2_76_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)02197-4"},{"key":"e_1_3_2_77_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2025.0285"},{"key":"e_1_3_2_78_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht134"},{"key":"e_1_3_2_79_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw210"},{"key":"e_1_3_2_80_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2024.1450"},{"key":"e_1_3_2_81_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(25)00439-8"},{"key":"e_1_3_2_82_2","doi-asserted-by":"publisher","DOI":"10.1080\/01616412.2020.1839690"},{"key":"e_1_3_2_83_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2021.785836"},{"key":"e_1_3_2_84_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2214299"},{"key":"e_1_3_2_85_2","doi-asserted-by":"publisher","DOI":"10.1177\/23969873241293323"},{"key":"e_1_3_2_86_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000213863"},{"key":"e_1_3_2_87_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(22)00519-1"},{"key":"e_1_3_2_88_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.122.039182"},{"key":"e_1_3_2_89_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)00981-4"},{"key":"e_1_3_2_90_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2021.796046"},{"key":"e_1_3_2_91_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2014-308401"},{"key":"e_1_3_2_92_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.123.043937"},{"key":"e_1_3_2_93_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25756"},{"key":"e_1_3_2_94_2","doi-asserted-by":"publisher","DOI":"10.1111\/ene.14199"},{"key":"e_1_3_2_95_2","doi-asserted-by":"publisher","DOI":"10.1161\/SVIN.123.000866"},{"key":"e_1_3_2_96_2","doi-asserted-by":"publisher","DOI":"10.3389\/fnagi.2021.692942"},{"key":"e_1_3_2_97_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000008317"},{"key":"e_1_3_2_98_2","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000257817.29883.48"},{"key":"e_1_3_2_99_2","doi-asserted-by":"publisher","DOI":"10.1177\/23969873231219416"},{"key":"e_1_3_2_100_2","doi-asserted-by":"publisher","DOI":"10.1177\/2396987319832140"},{"key":"e_1_3_2_101_2","doi-asserted-by":"publisher","DOI":"10.1161\/SVIN.122.000512"},{"key":"e_1_3_2_102_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199512143332401"},{"key":"e_1_3_2_103_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0804656"},{"key":"e_1_3_2_104_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.115.011528"},{"key":"e_1_3_2_105_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-014-1859-5"},{"key":"e_1_3_2_106_2","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.124.048248"},{"key":"e_1_3_2_107_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-014-1957-4"},{"key":"e_1_3_2_108_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2021-326308"},{"key":"e_1_3_2_109_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.124.036275"},{"key":"e_1_3_2_110_2","doi-asserted-by":"publisher","DOI":"10.1159\/000505241"},{"key":"e_1_3_2_111_2","doi-asserted-by":"publisher","DOI":"10.1161\/SVIN.122.000595"},{"key":"e_1_3_2_112_2","doi-asserted-by":"publisher","DOI":"10.1177\/17474930251314395"},{"key":"e_1_3_2_113_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(25)00549-5"},{"key":"e_1_3_2_114_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.125.049454"}],"container-title":["Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/STROKEAHA.125.053504","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T19:01:08Z","timestamp":1769454068000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/STROKEAHA.125.053504"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":113,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1161\/STROKEAHA.125.053504"],"URL":"https:\/\/doi.org\/10.1161\/strokeaha.125.053504","relation":{},"ISSN":["0039-2499","1524-4628"],"issn-type":[{"value":"0039-2499","type":"print"},{"value":"1524-4628","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]},"assertion":[{"value":"2025-08-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-08","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}