What is your approach to managing patients who initially present with symptomatic intracranial large vessel occlusion but subsequently experience resolution of symptoms or become non-disabling before any intervention?

If a large vessel occlusion (LVO), such as ICA-terminus, M1, or Basilar, is present, I would treat it even if there has been a significant improvement in symptoms. As mentioned in the prior post, an occlusion in one of these areas will likely exhaust collateral reserves and become symptomatic again....

It’s a tough call and a highly individualized decision each time. No randomized trial adequately accounts for all the factors I consider: whether it’s presumed to be ICAD or an embolus, availability of a perfusion study, collateral flow on CTA, the technical feasibility of the procedure, the burden ...

A lot of great answers.

If the patient is not clinically having symptoms, it is hard to justify putting the patient through a procedure that could worsen their neurological status.

If the patient has fluctuating symptoms, then the answer is likely to intervene (unable to respond to medical managemen...

I agree with all the above answers. Due to lack of current trials - the approach is often case based. For basilar and ICA terminus and M1 and proximal M2- if the symptoms have fully resolved (not mild symptoms but full resolution- if there are even mild symptoms - patients are taken for thrombectomy...