Intravenous alteplase in minor nondisabling ischemic stroke: A systematic review and meta-analysis.

IF 5.8 3区医学 Q1 CLINICAL NEUROLOGY European Stroke Journal Pub Date : 2024-09-01 Epub Date: 2024-03-11 DOI:10.1177/23969873241237312

Adel Alhazzani, Fahad S Al-Ajlan, Ahmed Alkhiri, Ahmed A Almaghrabi, Aser F Alamri, Basil A Alghamdi, Hassan K Salamatullah, Abdullah R Alharbi, Maher B Almutairi, Hui-Sheng Chen, Yongjun Wang, Mohamad Abdalkader, Guillaume Turc, Pooja Khatri, Thanh N Nguyen

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Abstract

Background: 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.

Materials and methods: 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).

Results: 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]; I² = 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.

Conclusion: This meta-analysis of minor nondisabling stroke suggests that IVA did not prove more beneficial compared to no-IVA.

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静脉注射阿替普酶治疗轻度非致残性缺血性脑卒中：系统回顾和荟萃分析。

背景：入院时美国国立卫生研究院卒中量表评分为 0-5 分的轻微缺血性卒中占所有急性缺血性卒中的一半。静脉注射阿替普酶（IVA）在轻微脑卒中患者中的作用尚无定论；因此，我们对这些患者接受或不接受 IVA 治疗的临床结果进行了评估：我们检索了 Medline、Embase、Scopus 和 Cochrane 图书馆，直至 2023 年 8 月 1 日。纳入的研究仅限于报道轻度非致残性中风患者接受或不接受 IVA 治疗的英文文献。采用随机效应模型计算出了比值比 (OR) 及其相应的 95% CI。疗效结果包括 90 天后的功能预后优良率（修正的 Rankin 评分表 [mRS] 为 0-1）和良好率（mRS 为 0-2）。主要的安全性结果是症状性脑出血（sICH）：符合纳入标准的研究有五项，其中两项为研究性临床试验，三项为观察性研究，共有 2764 名患者（31.8% 为女性）。1559名患者（56.4%）接受了IVA治疗。对两项研究的汇总分析显示，两组患者的 90 天优良功能预后（OR 0.76 [95% CI, 0.51-1.13]；I2 = 0%）和 sICH 发生率（OR 3.76 [95% CI, 0.61-23.20]）无差异。在良好功能预后、90 天死亡率和 90 天中风复发率方面，各组间未观察到明显差异：这项针对轻微非致残性卒中的荟萃分析表明，与无 IVA 相比，IVA 并未证明更有益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.