The Clinical Research Of Multi-Modality Assessment-Based Strategies For Intravenous Thrombolysis In Acute Mild Ischemic Stroke Patients

Background and Purpose:Acute mild ischemic stroke is considered to be a potentially dynamic process.Up to 30%among them suffer neurologic deterioration,and nearly 10%undergo disable stroke recurrence.Nevertheless,optimal medical approaches of such patients remain controversial given the efficacy and safety of intravenous thrombolysis.How to screen high-risk patients suitable for intravenous thrombolysis is essential for individual therapy.The purpose of this retrospective study was to evaluate the efficacy and safety of intravenous thrombolysis in acute mild ischemic stroke patients(National Institution of Health Stroke Scale ?5),moreover,to verify the effectiveness of multi-modality assessment in screening high-risk patients.Methods:Among 3321 patients with a final diagnosis of acute ischemic stroke or transient ischemic attack,we retrospectively included 227 patients identified with NIHSS?5 treated with or without intravenous thrombolysis.Odds ratios(OR)with their confidence intervals(CI)for different outcomes between groups were assessed by using univariable analysis or multivariable binary logistic regression analyses.And the heterogeneity of treatment effect magnitude for excellent outcome[modified Rankin scale(mRS)0-1]was estimated in different subgroups stratified by optimal cut-off value from receiver operating characteristic curve.Results:A total of 227 cases were enrolled,108 receiving intravenous thrombolysis and 119 treated with secondary stroke prevention strategies alone.In addition to history of atrial fibrillation and hyperlipidemia,the baseline characteristics of these two groups were generally balanced.Excellent outcomes were achieved in 163(71.8%)patients.In univariate analysis,the percentage of excellent outcome was significantly higher in patients receiving intravenous thrombolytic therapy(78.7%vs 65.5%,?2=4.841,P=0.028).In multivariate analysis,intravenous thrombolysis could both achieve higher rate of excellent outcome(OR,3.302;95%CI,1.488-7.326;P=0.003)and 7-day significant improvement(29.6%vs 14.3%;OR,2.566;95%CI,1.287-5.118;P=0.007).While there was no significant difference in the risk of early neurological deterioration,intracranial hemorrhage transformation or the 90-day recurrent stroke(P>0.05).It was indicated from the subgroup analysis that,eompared with non-thrombolytic group,the classification of large artery atherosclerosis(63.9%vs 52.6;OR,9.448;95%CI,1.129-79.035;P=0.038)and baseline ABCD2 score of 5 or more(72.5%vs 62.8;OR,2.664;95%CI,1.150-6.168;P=0.022)might benefit more from intravenous thrombolysis.Besides,baseline ASPECTS score>12,better collateral circulation,ischemic perfusion volume<36ml and infarction core volume<8.5ml were independent predictors for excellent outcome after intravenous thrombolysis.Conclusions:For acute mild ischemic stroke patients,we reassured the safety and especially the efficacy of intravenous thrombolysis at 7-and 90-days.Patients with ABCD2 score of 5 or more and the classification of large artery atherosclerosis might benefit more from intravenous thrombolytic therapy.