Efficacy of intravenous thrombolysis in patients with mild acute ischemic stroke and large vessel occlusion with different hypoperfusion volumes.

OBJECTIVES

To investigate early treatment strategies for patients with mild acute ischemic stroke and large vessel occlusion, we evaluated the efficacy of intravenous thrombolysis in patients with mild stroke and large vessel occlusion in different hypoperfusion volumes.

METHODS

Cohort data of consecutive patients (October 2021 to June 2024) with anterior circulation large vessel occlusion mild stroke (NIHSS ≤ 5) with onset < 24 h were retrospectively analyzed. We compared the outcomes of patients treated with intravenous thrombolysis (IVT) and dual antiplatelet therapy (DAPT). The outcomes of patients on IVT and DAPT were then compared between the large-volume hypoperfusion group (> 65 ml) and the small-volume hypoperfusion group (≤ 65 ml) based on the hypoperfusion volume of CT perfusion (Tmax > 6s).

RESULTS

A total of 222 patients were enrolled in the study (62 IVT, 160 DAPT). In 111 patients with small-volume hypoperfusion, there was no statistically significant difference in the rate of good prognosis (mRS0-1) at 90 days, the rate of early neurological deterioration and the rate of intracranial hemorrhage between the IVT and DAPT groups (P > 0.05). In another 111 patients with large-volume hypoperfusion, the IVT group had a higher rate of good prognosis (mRS0-1) at 90 days (OR:3.639,95%CI:1.249 ~ 10.601, P:0.018) and a higher rate of intracranial hemorrhage (OR:11.029, 95%CI:1.015 ~ 119.873, P:0.049) compared to the DAPT group.

CONCLUSIONS

In mild acute ischemic stroke patients with large-volume hypoperfusion and large-vessel occlusion, IVT has a higher rate of intracranial hemorrhage but a higher proportion of excellent functional outcomes compared with DAPT. Further randomized controlled trials are needed.