Managing patients presenting with large vessel occlusion (LVO) and mild stroke symptoms has been a challenging clinical scenario. Acute stroke therapy is often withheld for these patients; however, their natural clinical outcomes may not be favorable. Identifying patients who do well without treatment is not straightforward. In the absence of randomized clinical trials evaluating this specific population, acute stroke therapy remains a clinical conundrum. Intravenous thrombolysis alone appears safe, but may not be efficacious for proximal large vessel occlusions based on prior scientific data. Mechanical thrombectomy (MT) has been shown to achieve good recanalization rates and clinical outcomes in LVO patients with moderate-to-severe strokes, but it has not been widely studied in patients with low National Institute of Health Stroke Scale (NIHSS) scores. In this chapter, we review current data looking at this unique cohort, and discuss natural history, management options, ongoing research, and future directions.
