Efficacy and safety of intravenous thrombolysis in patients with mild acute ischemic stroke

Objective To evaluate the efficacy and safety of intravenous thrombolysis in patients with minor acute ischemic stroke (AIS). Methods In this retrospective cohort study, adult patients with minor AIS within 4.5 hours of onset between May 2009 and December 2024 were enrolled from four hospitals in Zhejiang province. Minor AIS was defined as a National Institutes of Health Stroke Scale (NIHSS) score ≤5, with a limb motor subscore of 0, and a score ≥2 in any of the following items: best gaze, visual fields, facial palsy, limb ataxia, sensation, best language, dysarthria, or neglect. Logistic regression and general linear models were used to assess the impact of intravenous thrombolysis on 3-month functional outcomes and safety endpoints. Results Among 347 enrolled patients, 206 (59.4%) received intravenous thrombolysis. The proportion of patients achieving a favorable functional outcome (modified Rankin scale score 0-1) at 3 months was signifi-cantly higher in the thrombolysis group than in the non-thrombolysis group (76.2% vs. 66.0%; adjusted OR=1.729, 95%CI: 1.016-2.940, P=0.043). The thrombolysis group also had a significantly lower all-cause mortality rate (1.0% vs. 12.8%; adjusted OR=0.074, 95%CI: 0.015-0.379, P=0.002). Safety analysis showed hemorrhagic transformation in 5.8%, parenchymal hemorrhage in 1.9%, and symptomatic intracranial hemorrhage in 2.9% of the thrombolysis group, compared with 3.5% hemorrhagic transformation in the non-thrombolysis group, with no statistically significant differences between the two groups (all P>0.05). Conclusion Intravenous thrombolysis can significantly improve 3-month functional outcomes and reduce mortality in patients with minor AIS without increasing the risk of hemorrhagic transformation.