School of Public Health, China Medical University, Shenyang, China (Y.Z., X.B., D.C., Y.S.).
Department of Neurology, Zhuji Affliated Hospital of WenZhou University, China (T.L.).
Stroke. 2024 Apr;55(4):883-892. doi: 10.1161/STROKEAHA.123.045495. Epub 2024 Mar 11.
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.
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).
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.
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.
溶栓治疗（IVT）在轻度卒中（国立卫生研究院卒中量表评分，0-5）中的疗效仍不确定。本研究旨在通过对随机对照试验和观察性研究进行系统评价和荟萃分析，比较 IVT 与最佳药物治疗（BMT）的有效性和安全性。
我们检索了 PubMed、Embase、Cochrane 图书馆和 Web of Science 数据库，以获取截至 2023 年 8 月 10 日有关轻度卒中 IVT 的相关文章。主要结局是 90 天时改良 Rankin 量表评分 0 或 1 的良好功能结局。使用比值比（OR）计算了总体和预先制定的亚组的相关性。本研究在 PROSPERO（CRD42023445856）上进行了注册。
共纳入 20 项高质量研究，包含 13397 例急性轻度缺血性卒中患者。IVT 组和 BMT 组在改良 Rankin 量表评分 0-1（OR，1.10[95%CI，0.89-1.37]）和 0-2（OR，1.16[95%CI，0.95-1.43]）、死亡率（OR，0.67[95%CI，0.39-1.15]）、复发性卒中（OR，0.89[95%CI，0.57-1.38]）和复发性缺血性卒中（OR，1.09[95%CI，0.68-1.73]）方面无显著差异。IVT 组与 BMT 组之间早期神经功能恶化（OR，1.81[95%CI，1.17-2.80]）、症状性颅内出血（OR，7.48[95%CI，3.55-15.76]）和出血性转化（OR，4.73[95%CI，2.40-9.34]）存在差异。在亚组中，非致残性缺损患者或使用抗血小板药物的患者中，改良 Rankin 量表评分 0-1 的比较结果保持不变。
这些发现表明，IVT 不能显著改善急性轻度缺血性卒中患者的功能预后。此外，与 BMT 相比，IVT 与症状性颅内出血风险增加相关。此外，在非致残性缺损患者或使用抗血小板药物的患者中，IVT 可能不比 BMT 更具优势。
