Efficacy and safety of intravenous thrombolytic therapy in patients with ischemic stroke and mild neurological deficit

Abstract

Intravenous thrombolytic therapy (IV TLT) is the main method of reperfusion therapy for ischemic stroke (IS). Almost half of IS patients present with a mild neurological deficit at onset, for which the efficacy of IV TLT remains controversial.

Objective: to assess the efficacy and safety of IV TLT in patients with IS and mild neurological deficit depending on the degree of stenosis of the main arteries of the head (MAH), regardless of the level of disability.

Material and methods. A total of 166 patients with IS and mild neurological deficit (less than 5 points on the NIHSS stroke severity scale) were observed: 82 patients received IV TLT, and 84 patients formed the comparison group.

Results. At hospital discharge, IS patients who received IV TLT showed a lower severity of neurological deficit on the NIHSS scale (U(82,84)=1882; p<0.001) and a better functional outcome according to the modified Rankin Scale (U(82,84)=1854; p<0.001) and the Rivermead Mobility Index (U(82,84)=1795; p<0.001). In the subgroup of patients with significant MAH stenosis, statistically significant advantages of IV TLT were also found according the NIHSS, Rankin Scale, and Rivermead Index. Hemorrhagic transformations occurred in the IV TLT group in 14 patients, and in the comparison group in 6 patients (only a trend toward increased frequency).

Conclusion. IV TLT in patients with IS and mild neurological deficit improves functional outcomes in the acute period of stroke. IV TLT is also effective in the subgroup of patients with significant MAH stenosis.