Key result
IVT linked to preventing the ~218% greater early neurological deterioration risk from large vessel stenosis.
Why the study?
The benefit of intravenous thrombolysis in minor ischemic stroke patients remains controversial, and the incidence and risk factors of early neurological deterioration in minor non-disabling patients required determination.
Does intravenous thrombolysis prevent early neurological deterioration in minor non-disabling ischemic stroke patients with large vessel stenosis or occlusion?
Observational (n=326)
No
Does intravenous thrombolysis prevent early neurological deterioration in minor non-disabling ischemic stroke patients with large vessel stenosis or occlusion?
Effect estimate: OR 2.828 for large vessel stenosis or occlusion in IVT group (not significant), OR 3.681 in no IVT group (95% CI IVT group 0.564–14.180; no IVT group 1.477–9.173)
Absolute Event Rate: 10% vs 32%
p-value: p=IVT group P=0.206 (not significant); no IVT group P=0.005 (significant)
Large vessel stenosis or occlusion is an independent risk factor for early neurological deterioration in minor non-disabling stroke, but intravenous thrombolysis may mitigate this risk.
Large vessel stenosis signals higher deterioration risk without IVT; hypothesis-generating for thrombolysis benefit, pending randomized confirmation.
Background The benefit of intravenous thrombolysis (IVT) in minor ischemic stroke patients still is controversial. Objective The incidence and risk factors of early neurological deterioration (END) in minor non-disabling patients were determined. Methods The data was obtained from minor ischemic stroke patients in our hospital from July 2019 to March 2025. Minor non-disabling stroke was identified as patients with the National Institutes of Health Stroke Scale (NIHSS) score ≤ 3. The neurological deficits did not prevent patients from performing basic activities of daily living (ADL) (such as bathing, ambulating, toileting, hygiene, and eating) according to the initial ADL scores and descriptions found in the medical records. END was defined as an increase in the total NIHSS score ≥ 2 over the baseline within 72 h of the stroke onset. Furthermore, at least one component of the increase in the total NIHSS score was an increase that was ≥ 1 in movement ability (5a-6b) or consciousness level (1a-1c) or new onset neurological deficits. Results Among 831 minor AIS patients, we retrospectively identified 326 (39.2%) minor non-disabling AIS patients, of whom 42 (12.9%) patients experienced END. Forty-eight (14.7%) patients experienced large vessel stenosis or occlusion. One hundred fourteen patients accepted intravenous thrombolysis. In entire minor non-disabling patients, large vessel stenosis or occlusion (31% vs. 12.3%, P 1 = 0.004; OR 3.176, 95% CI1.457–6.926, P 2 = 0.004) was independently associated with END. Through subgroup analysis, we also found that large vessel stenosis or occlusion (33.3% vs. 13.7%, P 1 = 0.014; OR 3.681, 95% CI1.477–9.173, P 2 = 0.005) was independently associated with END in the patients without IVT. However, among the patients with IVT, no significant association of large vessel stenosis or occlusion (25.0% vs. 9.8%, P 1 = 0.139; OR 2.828, 95% CI ,0.564–14.180, P 2 = 0.206) was found in END. Conclusion Large vessel stenosis or occlusion was independently associated with END in entire minor non-disabling patients or the patients without IVT. However, among the patients with IVT, no significant association of large vessel stenosis or occlusion was found in END. In other words, IVT might work in preventing these special patients from END.
No takes yet. Share an insight, caveat, or question.
Tang et al. (2026) conducted an observational in minor non-disabling acute ischemic stroke (n=326). Intravenous thrombolysis (IVT) vs. no intravenous thrombolysis was evaluated on Early neurological deterioration (END) defined as increase in NIHSS score ≥ 2 within 72 h of stroke onset (OR 2.828 for large vessel stenosis or occlusion in IVT group (not significant), OR 3.681 in no IVT group, 95% CI IVT group 0.564–14.180; no IVT group 1.477–9.173, p=IVT group P=0.206 (not significant); no IVT group P=0.005 (significant)). Large vessel stenosis or occlusion independently increased risk of early neurological deterioration (OR 3.176, 95% CI 1.457–6.926, P=0.004) in minor non-disabling stroke patients without IVT, but not in those with IVT, suggesting IVT may prevent deterioration in these patients.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: