Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Alfaisal University, Riyadh, Saudi Arabia.
Eur Stroke J. 2024 Sep;9(3):521-529. doi: 10.1177/23969873241237312. Epub 2024 Mar 11.
Minor ischemic stroke, defined as National Institute of Health Stroke Scale score of 0-5 on admission, represents half of all acute ischemic strokes. The role of intravenous alteplase (IVA) among patients with minor stroke is inconclusive; therefore, we evaluated clinical outcomes of these patients treated with or without IVA.
We searched Medline, Embase, Scopus, and the Cochrane library until August 1, 2023. Inclusion was restricted to the English literature of studies that reported on minor nondisabling stroke patients treated with or without IVA. Odds ratios (ORs) with their corresponding 95% CIs were utilized using a random-effects model. Efficacy outcomes included rates of excellent (modified Rankin scale [mRS] of 0-1) and good (mRS of 0-2) functional outcome at 90 days. The main safety outcome was symptomatic intracerebral hemorrhage (sICH).
Five eligible studies, two RCTs and three observational studies, comprising 2764 patients (31.8% female) met inclusion criteria. IVA was administered to 1559 (56.4%) patients. Pooled analysis of the two RCTs revealed no difference between the two groups in terms of 90-days excellent functional outcomes (OR 0.76 [95% CI, 0.51-1.13]; = 0%) and sICH rates (OR 3.76 [95% CI, 0.61-23.20]). No significant differences were observed between the groups in terms of good functional outcomes, 90-day mortality, and 90-day stroke recurrence.
This meta-analysis of minor nondisabling stroke suggests that IVA did not prove more beneficial compared to no-IVA.
轻度缺血性卒中定义为入院时国立卫生研究院卒中量表评分 0-5，占所有急性缺血性卒中的一半。静脉注射阿替普酶（IVA）在轻度卒中患者中的作用尚无定论；因此，我们评估了这些患者接受或不接受 IVA 治疗的临床结局。
我们检索了 Medline、Embase、Scopus 和 Cochrane 图书馆，截至 2023 年 8 月 1 日。纳入标准仅限于报告了接受或不接受 IVA 治疗的轻度非致残性卒中患者的英语文献。使用随机效应模型计算了比值比（OR）及其相应的 95%置信区间（CI）。疗效结局包括 90 天的优秀（改良 Rankin 量表 [mRS] 为 0-1）和良好（mRS 为 0-2）功能结局的发生率。主要安全性结局是症状性颅内出血（sICH）。
符合纳入标准的有五项研究，其中两项为 RCT，三项为观察性研究，共纳入 2764 例患者（31.8%为女性）。IVA 治疗组 1559 例（56.4%）。两项 RCT 的汇总分析显示，两组在 90 天的优秀功能结局（OR 0.76 [95%CI，0.51-1.13]； = 0%）和 sICH 发生率（OR 3.76 [95%CI，0.61-23.20]）方面无差异。两组在良好功能结局、90 天死亡率和 90 天卒中复发率方面无显著差异。
这项对轻度非致残性卒中的荟萃分析表明，与不使用 IVA 相比，IVA 并没有证明更有益。
