The rationale for IV thrombolysis in patients with lacunar infarcts is debated, since it is hypothesised that the microvascular occlusion underlying lacunar infarcts might not be susceptible to pharmacological reperfusion treatment.
An editorial notes that whilst the analysis is post hoc, exploratory, and likely underpowered, it is of the opinion that it further tips the scales strongly in favour of thrombolysis treatment of lacunar strokes. It adds that the primary results of the WAKE-UP trial provide definitive data that the availability of rapid MRI will allow clinicians to use thrombolysis to provide a meaningfully improved clinical outcomes for an additional population of patients.