Intravenous thrombolysis for mild stroke: NIHSS 3-5 Versus NIHSS 0-2

Area of Science:

• Neurology
• Cardiovascular Medicine
• Emergency Medicine

Background:

• Intravenous thrombolysis is a critical treatment for acute ischemic stroke.
• Previous studies suggest potential benefit in mild stroke patients (NIHSS 3-5) but not in those with minimal symptoms (NIHSS 0-2).
• Real-world data is needed to clarify treatment effectiveness and outcomes in different severity groups.

Purpose of the Study:

• To compare the safety and effectiveness of thrombolysis in mild ischemic stroke patients with NIHSS scores of 0-2 versus 3-5.
• To identify predictors of excellent functional outcomes in these patient groups.
• To analyze data from a prospective, real-world longitudinal registry.

Main Methods:

• Prospective registry of acute ischemic stroke patients treated within 4.5 hours of symptom onset with NIHSS ≤ 5.
• Collected demographic, clinical, imaging, and laboratory data.
• Assessed functional outcome (modified Rankin Scale 0-1) and safety (symptomatic intracerebral hemorrhage).
• Used multivariable regression to analyze safety, effectiveness, and outcome predictors.

Main Results:

• Patients with NIHSS 0-2 (n=80) showed significantly better functional outcomes (81.3%) compared to NIHSS 3-5 (n=156) (48.7%) (aOR 0.40, P=0.04).
• Thrombolysis in the NIHSS 0-2 group did not increase symptomatic intracerebral hemorrhage or mortality rates.
• Non-disabling stroke and prior statin therapy were independent predictors of excellent functional outcomes.

Conclusions:

• Acute ischemic stroke patients with NIHSS 0-2 experience better functional outcomes post-thrombolysis than those with NIHSS 3-5 within the 4.5-hour window.
• Minor stroke severity, non-disabling stroke, and prior statin use are key predictors of favorable discharge outcomes.
• Larger studies are warranted to validate these findings.