“Minor” stroke: not a minor, still open question

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

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.

Developing a Nomogram to Predict the Probability of Subsequent Vascular Events at 6-Month in Chinese Patients with Minor Ischemic Stroke

Purpose

To develop a nomogram to predict the risk of subsequent vascular events (SVE) at 6-month in Chinese patients with minor ischemic stroke (MIS).

Patients and Methods

We performed a retrospective analysis of 260 MIS patients, which were randomly divided into a derivation set (193 cases) and a verification set (67 cases) at a ratio of 3:1. Multi-factor logistic regression was used to construct a predictive model of SVE from the derivation set and verify it in the verification set.

Results

Finally, there were 51 cases (19.6%) of SVE in 260 MIS cases. Age, fasting blood glucose, metabolic syndrome, number of lesions found on MRI, and the infarct size were used to construct the prediction model and nomogram. The AUC in the derivation set was 0.901, with a sensitivity of 0.795, a specificity of 0.877, a positive likelihood ratio of 6.443, and a negative likelihood ratio of 0.234. The AUC in the verification set was 0.897, which was not significantly different from the derivation set (P = 0.937). The predictive model based on clinical parameters has good diagnostic efficiency and robustness.

Conclusion

The nomogram can provide personalized predictions for the 6-month SVE risk in Chinese MIS patients.

Relationship between fasting blood glucose and subsequent vascular events in Chinese patients with mild ischaemic stroke: a cohort study

Objective

To characterise the relationship between fasting blood glucose (FBG) and the incidence of subsequent vascular events (SVE) during the 6 months following a mild ischaemic stroke (MIS) in Chinese patients.

Methods

Data from patients with MIS were retrospectively analysed. The primary endpoint was an SVE during the 6-month follow-up period. The participants were allocated to three groups (tertiles), according to their FBG concentration.

Results

Of the 260 participants, 51 (19.6%) reported an SVE during the follow-up period. The incidence of SVE significantly differed among the tertiles of FBG. The odds ratio (OR) was 2.361 (95% confidence interval [CI]: 1.551–3.594) for FBG as a continuous variable and that for FBG categorised according to tertile was 13.30 (95% CI: 3.519–50.322) in the fully adjusted model. Curve fitting showed that the incidence of SVE gradually increased with increasing FBG, with the highest tertile showing the highest mean incidence (46.7%; 95% CI: 16.2%–79.9%). In addition, participants with or without diabetes mellitus, hypertension, headache, dizziness, mild cognitive impairment or anterior circulation artery lesion showed similar associations between FBG and the incidence of SVE.

Conclusion

FBG is an independent predictor of 6-month SVE risk in Chinese patients with MIS.

Effect of rt-PA intravenous thrombolysis on the prognosis of patients with minor ischemic stroke

AIMS

The evidence of rt-PA intravenous thrombolysis in patients with minor ischemic stroke (MIS) is still controversial. This study aims to investigate the effect of rt-PA intravenous thrombolysis on the prognosis of patients with MIS.

METHODS

We continuously enrolled and analyzed patients with MIS admitted into our hospital within 24 h after symptom onset between January 2016 and December 2018, including 96 patients received intravenous thrombolysis within 4.5 h after symptom onset and 84 patients not received intravenous thrombolysis. A favorable long-term outcome was a 90-day mRS score of 0-1. Good short-term outcome was a 7-day NIHSS score of 0 or less than NIHSS onset.

RESULTS

There were no statistical differences between two groups of patients' age, gender, history of hypertension, coronary heart disease, atrial fibrillation, smoking, drinking, and baseline NIHSS score. Patients with history of stroke (22.62% vs. 10.42%, p < 0.05) and diabetes (46.43% vs. 22.92%, p = 0.01) were higher in group of non-thrombolysis. The difference of NIHSS score after 7 days was statistically different between the two groups (p < 0.05), while there was no significant difference in 90-day mRS score. Logistic regression analysis indicated that the prognosis of patients was correlated with neutrophil ratio and CRP at admission.

CONCLUSION

Patients with MIS received intravenous thrombolysis may be associated with earlier neurological improvement, but might has no significant effect on long-term prognosis. The level of neutrophil ratio and CRP at admission are risk factors determining the prognosis, which requires further research.