Outcomes in minor stroke patients treated with intravenous thrombolysis

Chunmiao Duan; Yunyun Xiong; Hong-Qiu Gu; Shang Wang; Kai-Xuan Yang; Manjun Hao; Xingquan Zhao; Xia Meng; Yongjun Wang

doi:10.1111/cns.14164

Outcomes in minor stroke patients treated with intravenous thrombolysis

CNS Neurosci Ther. 2023 Aug;29(8):2308-2317. doi: 10.1111/cns.14164. Epub 2023 Mar 21.

Authors

Chunmiao Duan^{1

2

3}, Yunyun Xiong^{1

2

4}, Hong-Qiu Gu^{2

5}, Shang Wang⁶, Kai-Xuan Yang^{2

5}, Manjun Hao², Xingquan Zhao^{1

2}, Xia Meng², Yongjun Wang^{1

2

5

7}

Affiliations

¹ Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
² China National Clinical Research Center for Neurological Diseases, Beijing, China.
³ Department of Neurology, Beijing Daxing Hospital, Capital Medical University, Beijing, China.
⁴ Chinese Institute for Brain Research, Beijing, China.
⁵ National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China.
⁶ Neurocardiology Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
⁷ Center for Stroke, Beijing Institute for Brain Disorders, Beijing, China.

Abstract

Aims: Our study aimed to describe the short-, medium-, and long-term outcomes of intravenous thrombolysis in minor stroke, and to explore the relationship between thrombolysis and clinical outcomes.

Methods: Our study included ischemic minor stroke patients (National Institutes of Health Stroke Scale score ≤ 5) within 4.5 h from symptom onset from the Third China National Stroke Registry (CNSR-III) between August 2015 and March 2018. The primary outcome was a favorable functional outcome, defined as a modified Rankin Scale (mRS) score of 0-1 at 3 months. The secondary outcomes included mRS score of 0-1 at discharge, 6 months, and 1 year. The safety outcomes were symptomatic intracerebral hemorrhage (sICH) at 24-36 h and all-cause mortality. The association between intravenous thrombolysis and clinical outcomes was studied using multivariable models.

Results: A total of 1905 minor ischemic stroke patients were included. Overall 527 patients (28%) received intravenous t-PA (IV t-PA) and 1378 patients (72%) in the non-IV t-PA group. Of them, 18.85% (359/1905) participants had a disabled outcome (defined as mRS score ≥ 2) at discharge, 12.8% (242/1885) at 3 months, 13.9% (262/1886) at 6 months, and 13.9% (260/1871) at 1 year. In multivariable analysis, IV t-PA was associated with favorable functional outcomes at discharge (adjusted odds ratio [aOR] 1.49; 95% confidence interval [CI] 1.13-1.96; p = 0.004), 3 months (aOR 1.51; 95% CI 1.09-2.10; p = 0.01), 6 months (aOR 1.64; 95% CI 1.19-2.27; p = 0.003), and 1 year (aOR 1.52; 95% CI 1.10-2.10; p = 0.01). Symptomatic ICH occurred in 3 (0.6%) patients in IV t-PA versus 2 (0.1%) in the non-IV t-PA group. No significant differences were found in all-cause mortality between the two groups.

Conclusions: Intravenous t-PA may be safe and effective in minor stroke (NIHSS ≤ 5) within a 4.5-h window and further randomized controlled trials are warranted.

Keywords: minor stroke; outcome; stroke; thrombolysis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Administration, Intravenous
Brain Ischemia* / complications
Fibrinolytic Agents / therapeutic use
Humans
Ischemic Stroke* / drug therapy
Stroke*
Thrombolytic Therapy / adverse effects
Tissue Plasminogen Activator / adverse effects
Tissue Plasminogen Activator / therapeutic use
Treatment Outcome

Substances

Tissue Plasminogen Activator
Fibrinolytic Agents