Abstract
Thrombolysis treatment for patients with mild stroke is controversial. The aim of our study was to investigate whether patients with mild stroke or its specific etiologic subtype might benefit from rt-PA therapy. Data were derived from two cohorts of patients with and without rt-PA treatment: (1) the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China) and (2) the China National Stroke Registry (CNSR) database. Patients with mild stroke (defined as National Institutes of Health Stroke Scale ≤5) receiving the rt-PA therapy and without rt-PA therapy were matched in 1:2 for age, sex, stroke severity and etiologic subtype. A total of 134 rt-PA-treated patients were matched to 249 non-rt-PA-treated patients in the study. Among them, 104 (76%) rt-PA-treated patients with mild stroke had good outcome after 3 months compared with 173 (69.5%) non-rt-PA-treated matching cases (odds ratio [OR], 1.48; 95% confidence interval [CI], 0.91–2.43; P = 0.12). Compared with non-rt-PA-treated group, rt-PA-treated patients had good outcome after 3 months in those with stroke subtype of large-artery atherosclerosis (LAA) (80.5% vs 65.1%; OR, 2.19; 95%CI, 1.14–4.21; P = 0.02). For patients with mild stroke, intravenous rt-PA treatment may be effective. Patients with stroke subtype of LAA might benefit more from rt-PA treatment.
Highlights
3 million new strokes occur every year in China, and 30% of them are mild ischemic strokes[1, 2]
A total of 174 rt-PA treated patients with mild stroke and with complete baseline variables were identified in the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China[19] TIMS-China) registry, while 1225 non-rt-PA treated patients with mild stroke in the China National Stroke Registry (CNSR) registry[20]
One (0.7%) patient in rt-PA treatment group had symptomatic intracranial hemorrhage defined by ECASS II criteria during three months. This observational study showed that mild stroke patients who received intravenous rt-PA treatment obtained a high rate (77.6%) of good outcome, which was similar with previous study reported[21]
Summary
3 million new strokes occur every year in China, and 30% of them are mild ischemic strokes[1, 2]. The intravenous rt-PA treatment was considered as one of the most effective treatments for patients with acute ischemic stroke[7]. Few patients with mild stroke receive intravenous rt-PA therapy[8] because that thrombolysis treatment in acute phase to those patients is controversial[9]. Previous studies showed that 29% of patients with mild or rapidly improving symptoms not receiving thrombolysis led to poor outcome[11,12,13]. Previous study reported that different stroke etiology subtypes appeared as independent risk predictors for early worsening in patients with mild ischemic stroke[17]. We investigated whether patients with mild ischemic stroke could benefit from intravenous rt-PA therapy by comparing matched pairs of patients with and without receiving rt-PA. We hypnotized that the intravenous thrombolysis may have differential contribution to prognosis of the different subtypes of mild stroke
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