Minor Non-Disabling Stroke Patients with Large Vessel Severe Stenosis or Occlusion Might Benefit from Thrombolysis

Zhong, Wansi; Zhou, Ying; Zhang, Kemeng; Yan, Shiyu; Sun, Jianyong; Lou, Min

doi:10.3390/brainsci11070945

Cited by 5 publications

(9 citation statements)

References 26 publications

(31 reference statements)

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“…Eighteen studies 16,17,22–37 provided data on mRS scores of 0 to 1 at 90 days (Figure 2). Rates of excellent functional outcome in the IVT compared with BMT group revealed no significance (2252/2717, 82.89% versus 3295/4073, 80.90%, P =0.274; Table).…”

Section: Resultsmentioning

confidence: 99%

“…Three studies 26,29,33 provided data on hemorrhagic transformation (Figure 3). There was a higher rate of hemorrhagic transformation in the IVT group compared with BMT group (68/1036, 6.56% versus 10/648, 1.54%, P <0.001; Table), as well as higher odds of hemorrhagic transformation with IVT, with no heterogeneity (OR, 4.73 [95% CI, 2.40–9.34]; I ²=0%, P =0.987).…”

Section: Resultsmentioning

confidence: 99%

“…Primary Outcome: Excellent Functional Outcome of mRS Score of 0 to 1 Eighteen studies 16,17,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] provided data on mRS scores of 0 to 1 at 90 days (Figure 2). The pooled estimated effect on mRS score of 0 to 1 at 90 days was consistent in each predefined subgroup between patients who received IVT versus BMT, that is, age >80 Favorable Functional Outcome of mRS Score of 0 to 2 Thirteen studies 17,[22][23][24][25][27][28][29]31,[34][35][36][37] provided data on mRS scores of 0 to 2 at 90 days (Figure S1).…”

Section: Outcomementioning

confidence: 99%

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Intravenous Alteplase Versus Best Medical Therapy for Patients With Minor Stroke: A Systematic Review and Meta-Analysis

Zhang,

Lv,

Nguyen

et al. 2024

Stroke

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Background: The efficacy of thrombolysis (IVT) in minor stroke (National Institutes of Health Stroke Scale score, 0–5) remains inconclusive. The aim of this study is to compare the effectiveness and safety of IVT with best medical therapy (BMT) by means of a systematic review and meta-analysis of randomized controlled trials and observational studies. Methods: We searched the PubMed, Embase, Cochrane Library, and Web of Science databases to obtain articles related to IVT in minor stroke from inception until August 10, 2023. The primary outcome was an excellent functional outcome, defined as a modified Rankin Scale score of 0 or 1 at 90 days. The associations were calculated for the overall and preformulated subgroups by using the odds ratios (ORs). This study was registered with PROSPERO (CRD42023445856). Results: A total of 20 high-quality studies, comprised of 13 397 patients with acute minor ischemic stroke, were included. There were no significant differences observed in the modified Rankin Scale scores of 0 to 1 (OR, 1.10 [95% CI, 0.89–1.37]) and 0 to 2 (OR, 1.16 [95% CI, 0.95–1.43]), mortality rates (OR, 0.67 [95% CI, 0.39–1.15]), recurrent stroke (OR, 0.89 [95% CI, 0.57–1.38]), and recurrent ischemic stroke (OR, 1.09 [95% CI, 0.68–1.73]) between the IVT and BMT group. There were differences between the IVT group and the BMT group in terms of early neurological deterioration (OR, 1.81 [95% CI, 1.17–2.80]), symptomatic intracranial hemorrhage (OR, 7.48 [95% CI, 3.55–15.76]), and hemorrhagic transformation (OR, 4.73 [95% CI, 2.40–9.34]). Comparison of modified Rankin Scale score of 0 to 1 remained unchanged in subgroup patients with nondisabling deficits or compared with those using antiplatelets. Conclusions: These findings indicate that IVT does not yield significant improvement in the functional prognosis of patients with acute minor ischemic stroke. Additionally, it is associated with an increased risk of symptomatic intracranial hemorrhage when compared with the BMT. Moreover, IVT may not have superiority over BMT in patients with nondisabling deficits or those using antiplatelets.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Outcomementioning

confidence: 99%

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Intravenous Alteplase Versus Best Medical Therapy for Patients With Minor Stroke: A Systematic Review and Meta-Analysis

Zhang,

Lv,

Nguyen

et al. 2024

Stroke

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“…In the study, minor non‐disabling stroke was defined as patients with baseline NIHSS score ≤5 and a score of 0 or 1 on each baseline NIHSS score item (items 1a to 1c being 0). 25 However, these findings need to be verified in future randomized trials. We did not find a significant association between intravenous t‐PA and excellent outcome in disabling subgroup.…”

Section: Discussionmentioning

confidence: 99%

“…It showed that patients with such characteristics could benefit from intravenous alteplase. In the study, minor non‐disabling stroke was defined as patients with baseline NIHSS score ≤5 and a score of 0 or 1 on each baseline NIHSS score item (items 1a to 1c being 0) 25 . However, these findings need to be verified in future randomized trials.…”

Section: Discussionmentioning

confidence: 99%

Intravenous thrombolysis versus antiplatelet therapy in minor stroke patients with large vessel occlusion

Duan

Xiong

et al. 2023

CNS Neurosci Ther

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Aim Our study aimed to explore the effectiveness and safety of intravenous t‐PA compared with dual antiplatelet therapy (DAPT) and aspirin alone for minor stroke with National Institutes of Health Stroke Scale (NIHSS) score ≤5 and large vessel occlusion (LVO). Methods Patients with minor stroke harboring LVO within 4.5‐h time window were included from the Third China National Stroke Registry (CNSR‐III) between August 2015 and March 2018 in China. Clinical outcomes including modified Rankin scale (mRS) score, recurrent stroke, and all‐cause mortality at 90 days and 36‐h symptomatic intracerebral hemorrhage (sICH) were collected. Multivariable logistic regression models and propensity score matching analyses were used to determine the association between treatment groups and clinical outcomes. Results A total of 1401 minor stroke patients with LVO were included. Overall 251 patients (17.9%) received intravenous t‐PA, 722 patients (51.5%) received DAPT, and 428 patients (30.5%) received aspirin alone. The intravenous t‐PA was associated with greater proportions of mRS 0–1 (aspirin versus t‐PA: adjusted odds ratio [aOR], 0.50; 95% confidence interval [CI], 0.32 to 0.80; p = 0.004; DAPT versus t‐PA: aOR, 0.76; 95% CI, 0.49 to 1.19; p = 0.23). Using propensity score matching analyses, the results were similar. There was no difference in 90‐day recurrent stroke among the groups. The rates of all‐cause mortality in intravenous t‐PA, DAPT, and aspirin groups were 0%, 0.55%, 2.34%, respectively. No patient developed sICH within 36 h of intravenous t‐PA. Conclusion In patients with minor stroke harboring LVO within 4.5‐h time window, intravenous t‐PA was associated with higher odds for the excellent functional outcome, as compared with the aspirin alone. Further randomized controlled trials are warranted.

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Intravenous alteplase in minor nondisabling ischemic stroke: A systematic review and meta-analysis

Alhazzani,

Al-Ajlan,

Alkhiri

et al. 2024

European Stroke Journal

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Background: Minor ischemic stroke, defined as National Institute of Health Stroke Scale score of 0–5 on admission, represents half of all acute ischemic strokes. The role of intravenous alteplase (IVA) among patients with minor stroke is inconclusive; therefore, we evaluated clinical outcomes of these patients treated with or without IVA. Materials and methods: We searched Medline, Embase, Scopus, and the Cochrane library until August 1, 2023. Inclusion was restricted to the English literature of studies that reported on minor nondisabling stroke patients treated with or without IVA. Odds ratios (ORs) with their corresponding 95% CIs were utilized using a random-effects model. Efficacy outcomes included rates of excellent (modified Rankin scale [mRS] of 0–1) and good (mRS of 0–2) functional outcome at 90 days. The main safety outcome was symptomatic intracerebral hemorrhage (sICH). Results: Five eligible studies, two RCTs and three observational studies, comprising 2764 patients (31.8% female) met inclusion criteria. IVA was administered to 1559 (56.4%) patients. Pooled analysis of the two RCTs revealed no difference between the two groups in terms of 90-days excellent functional outcomes (OR 0.76 [95% CI, 0.51–1.13]; I2 = 0%) and sICH rates (OR 3.76 [95% CI, 0.61–23.20]). No significant differences were observed between the groups in terms of good functional outcomes, 90-day mortality, and 90-day stroke recurrence. Conclusion: This meta-analysis of minor nondisabling stroke suggests that IVA did not prove more beneficial compared to no-IVA.

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Minor Non-Disabling Stroke Patients with Large Vessel Severe Stenosis or Occlusion Might Benefit from Thrombolysis

Cited by 5 publications

References 26 publications

Intravenous Alteplase Versus Best Medical Therapy for Patients With Minor Stroke: A Systematic Review and Meta-Analysis

Intravenous Alteplase Versus Best Medical Therapy for Patients With Minor Stroke: A Systematic Review and Meta-Analysis

Intravenous thrombolysis versus antiplatelet therapy in minor stroke patients with large vessel occlusion

Intravenous alteplase in minor nondisabling ischemic stroke: A systematic review and meta-analysis

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