Mild stroke: safety and outcome in patients receiving thrombolysis

Objectives The aim of this study was to compare the short‐term clinical outcome of patients with acute cerebral ischemia and mild symptoms receiving rt‐PA with that of patients with acute cerebral ischemia and mild symptoms not treated with rt‐PA, and to investigate the frequency of symptomatic intracranial hemorrhage (sICH) in these patients. Materials and methods All patients with confirmed ischemic stroke/TIA and mild symptoms were included. Mild symptoms were defined as NIHSS score ≤5 on admission. Functional outcome was assessed with modified Rankin Scale (mRS) at day 7 or at earlier discharge. Excellent outcome was defined as mRS = 0. sICH was defined according to both NINDS and ECASS III criteria. Results Of 2753 patients with confirmed ischemic stroke/TIA admitted between February 2006 and February 2013, 966 (35.3%) were excluded because of having admission NIHSS >5. A total of 1791 patients presented with mild symptoms on admission (NIHSS ≤5), of which 158 (8.8%) patients received rt‐PA. Treatment with rt‐PA and early admission were independently associated with excellent outcome. Higher NIHSS score on admission and prior ischemic stroke were independently associated with poor outcome. Three (1.9%) sICH were diagnosed in rt‐PA‐treated patients and one (0.1%) in patients not receiving rt‐PA. Conclusions This study highlights the efficacy of rt‐PA in patients with acute cerebral ischemia presenting with mild symptoms and confirms the low‐risk profile of this treatment.