Intravenous Thrombolysis In Acute Minor Non-disabling Ischemic Stroke Patients

Part one Acute minor Non-disabling Stroke ischemic stroke patients can't benefit from intravenous thrombolysisBackground: We aimed to explore whether acute minor non-disabling stroke ischemic stroke patients can benefit from intravenous thrombolysis.Methods: We retrospectively reviewed our prospectively collected database for minor nondisabling AIS patients within 4.5 hours of onset at admission in our center during period from June 2009 to July 2019.Minor nondisabling AIS patients was defined as all patients with baseline NIHSS?5 and a score 0 or 1 on every baseline NIHSS score item,except level of consciousness items(items 1a to 1c),which must be 0.Good outcome was defined as modified Rankin Scale(m RS)?1 at 3-month.Results: 522 patients with minor nondisabling AIS were included.285(54.6%)patients being treated with alteplase.Compared with the alteplase-untreated patients,patients treated with alteplase were younger(67±12 VS 70±14,P =0.021),with lower baseline National Institute of Health Sroke Scale(NIHSS)score(3 VS 1,P <0.001),and had a higher proportion of smoking(40.4% vs 30.0%,P =0.018).Binary logistic regression showed that Alteplase-treatment was not an independent factor for m RS 0-1 both in entire cohort(OR=0.957,95%:0.575-1.594,P =0.866).Conclusion: Minor nondisabling AIS didn't benefit from alteplase-treatment,further clinical trails are needed.Part two Minor Non-disabling Stroke Patients with Large Vessel Severe Stenosis Benefit from intravenous ThrombolysisBackground: We aimed to explore whether minor non-disabling stroke patients with severe stenosis can benefit from intravenous thrombolysis.Methods: We used a prospectively collected database of AIS patients being assessed for thrombolysis with alteplase.Severe stenosis(70 ? stenosis < 100%)or occlusion of large vessels was categorized on CT or MR angiography.Minor nondisabling AIS patients was defined as all patients with baseline NIHSS?5 and a score 0 or 1 on every baseline NIHSS score item,except level of consciousness items(items 1a to 1c),which must be 0.The primary outcome was modified Rankin Scale(m RS)0-1 at 90-day.Results: 461 patients with minor nondisabling AIS were included(240 being treated with alteplase)and 113(24.5%)patients had severe stenosis/occlusion of large vessels.Alteplase-treatment was not an independent factor for m RS 0-1 among patients without severe stenosis/occlusion of large vessels(n=348),alteplase-treatment became an independent favorable factor for m RS 0-1(alteplase-treated 78.4% vs untreated 87.1%;p=0.343).However,among patients with severe stenosis/occlusion of large vessels(n=113),alteplase-treatment patients had higher proportion of good outcome compared with alteplase-untreated(alteplase-treated 74.4% vs untreated 45.7%;p=0.010).Conclusion: Minor nondisabling AIS due to severe stenosis/occlusion of large vessels might still benefit from alteplase-treatment.Part three Intravenous thrombolysis of acute minor Non-disabling Stroke Patients with the guidance of perfusion imagineBackground: We aimed to explore whether acute minor non-disabling stroke ischemic stroke patients can benefit from intravenous thrombolysis with the guidance of perfusion imagine.Methods: We used a prospectively collected database of AIS patients being assessed for thrombolysis with alteplase.The existence of hypoperfusion was evaluated on CT or MR perfusion.Minor nondisabling AIS patients was defined as all patients with baseline NIHSS?5 and a score 0 or 1 on every baseline NIHSS score item,except level of consciousness items(items 1a to 1c),which must be 0.The primary outcome was modified Rankin Scale(m RS)0-1 at 90-day.Results: 455 patients with minor nondisabling AIS were included(239 being treated with alteplase)and 227(49.9%)patients had hypoperfusion.Among minor nondisabling patients with baseline NIHSS>2 who had hypoperfusion on CTP,intravenous thrombolysis became an independent favorable factor for m RS 0-1(OR=3.705,95%:1.082-12.689,P 2=0.037).Conclusion: In selected Minor nondisabling AIS with baseline NIHSS>2 who had demonstrated hypoperfusion on CTP,intravenous thrombolysis is safe and associated with improve in functional outcome at 90 days.