Abstract：
UNASSIGNED: The efficacy of thrombolysis (IVT) in minor stroke (National Institutes of Health Stroke Scale score, 0-5) remains inconclusive. The aim of this study is to compare the effectiveness and safety of IVT with best medical therapy (BMT) by means of a systematic review and meta-analysis of randomized controlled trials and observational studies.
UNASSIGNED: We searched the PubMed, Embase, Cochrane Library, and Web of Science databases to obtain articles related to IVT in minor stroke from inception until August 10, 2023. The primary outcome was an excellent functional outcome, defined as a modified Rankin Scale score of 0 or 1 at 90 days. The associations were calculated for the overall and preformulated subgroups by using the odds ratios (ORs). This study was registered with PROSPERO (CRD42023445856).
UNASSIGNED: A total of 20 high-quality studies, comprised of 13 397 patients with acute minor ischemic stroke, were included. There were no significant differences observed in the modified Rankin Scale scores of 0 to 1 (OR, 1.10 [95% CI, 0.89-1.37]) and 0 to 2 (OR, 1.16 [95% CI, 0.95-1.43]), mortality rates (OR, 0.67 [95% CI, 0.39-1.15]), recurrent stroke (OR, 0.89 [95% CI, 0.57-1.38]), and recurrent ischemic stroke (OR, 1.09 [95% CI, 0.68-1.73]) between the IVT and BMT group. There were differences between the IVT group and the BMT group in terms of early neurological deterioration (OR, 1.81 [95% CI, 1.17-2.80]), symptomatic intracranial hemorrhage (OR, 7.48 [95% CI, 3.55-15.76]), and hemorrhagic transformation (OR, 4.73 [95% CI, 2.40-9.34]). Comparison of modified Rankin Scale score of 0 to 1 remained unchanged in subgroup patients with nondisabling deficits or compared with those using antiplatelets.
UNASSIGNED: These findings indicate that IVT does not yield significant improvement in the functional prognosis of patients with acute minor ischemic stroke. Additionally, it is associated with an increased risk of symptomatic intracranial hemorrhage when compared with the BMT. Moreover, IVT may not have superiority over BMT in patients with nondisabling deficits or those using antiplatelets.
UNASSIGNED: We searched the PubMed, Embase, Cochrane Library, and Web of Science databases to obtain articles related to IVT in minor stroke from inception until August 10, 2023. The primary outcome was an excellent functional outcome, defined as a modified Rankin Scale score of 0 or 1 at 90 days. The associations were calculated for the overall and preformulated subgroups by using the odds ratios (ORs). This study was registered with PROSPERO (CRD42023445856).
UNASSIGNED: A total of 20 high-quality studies, comprised of 13 397 patients with acute minor ischemic stroke, were included. There were no significant differences observed in the modified Rankin Scale scores of 0 to 1 (OR, 1.10 [95% CI, 0.89-1.37]) and 0 to 2 (OR, 1.16 [95% CI, 0.95-1.43]), mortality rates (OR, 0.67 [95% CI, 0.39-1.15]), recurrent stroke (OR, 0.89 [95% CI, 0.57-1.38]), and recurrent ischemic stroke (OR, 1.09 [95% CI, 0.68-1.73]) between the IVT and BMT group. There were differences between the IVT group and the BMT group in terms of early neurological deterioration (OR, 1.81 [95% CI, 1.17-2.80]), symptomatic intracranial hemorrhage (OR, 7.48 [95% CI, 3.55-15.76]), and hemorrhagic transformation (OR, 4.73 [95% CI, 2.40-9.34]). Comparison of modified Rankin Scale score of 0 to 1 remained unchanged in subgroup patients with nondisabling deficits or compared with those using antiplatelets.
UNASSIGNED: These findings indicate that IVT does not yield significant improvement in the functional prognosis of patients with acute minor ischemic stroke. Additionally, it is associated with an increased risk of symptomatic intracranial hemorrhage when compared with the BMT. Moreover, IVT may not have superiority over BMT in patients with nondisabling deficits or those using antiplatelets.
摘要：
■小卒中溶栓（IVT）的疗效（美国国立卫生研究院卒中量表评分，0-5）仍然没有定论。本研究的目的是通过对随机对照试验和观察性研究的系统评价和荟萃分析，比较IVT与最佳药物治疗（BMT）的有效性和安全性。
■我们搜索了PubMed，Embase,科克伦图书馆,和WebofScience数据库，以获取从开始到2023年8月10日与小卒中的IVT相关的文章。主要结果是出色的功能结果，定义为90天的改良Rankin量表评分为0或1。通过使用比值比（OR）计算总体和预先制定的亚组的关联。本研究在PROSPERO（CRD42023445856）注册。
■共20项高质量研究，由13397例急性轻微缺血性卒中患者组成，包括在内。在0至1的改良Rankin量表评分中没有观察到显着差异（OR，1.10[95%CI，0.89-1.37])和0至2(OR，1.16[95%CI，0.95-1.43])，死亡率（或，0.67[95%CI，0.39-1.15])，复发性中风（OR，0.89[95%CI，0.57-1.38])，和复发性缺血性卒中(OR，1.09[95%CI，0.68-1.73]）在IVT和BMT组之间。IVT组和BMT组在早期神经功能恶化方面存在差异（OR，1.81[95%CI，1.17-2.80])，症状性颅内出血（OR，7.48[95%CI，3.55-15.76])，和出血性转化(或，4.73[95%CI，2.40-9.34]）。在非致残性缺陷的亚组患者或与使用抗血小板药物的患者相比，改良的Rankin量表评分为0至1的比较保持不变。
■这些研究结果表明，IVT并未显著改善急性轻微缺血性卒中患者的功能预后。此外,与BMT相比,它与有症状的颅内出血风险增加相关.此外，在非致残性缺陷或使用抗血小板的患者中，IVT可能不具有优于BMT的优势。
■我们搜索了PubMed，Embase,科克伦图书馆,和WebofScience数据库，以获取从开始到2023年8月10日与小卒中的IVT相关的文章。主要结果是出色的功能结果，定义为90天的改良Rankin量表评分为0或1。通过使用比值比（OR）计算总体和预先制定的亚组的关联。本研究在PROSPERO（CRD42023445856）注册。
■共20项高质量研究，由13397例急性轻微缺血性卒中患者组成，包括在内。在0至1的改良Rankin量表评分中没有观察到显着差异（OR，1.10[95%CI，0.89-1.37])和0至2(OR，1.16[95%CI，0.95-1.43])，死亡率（或，0.67[95%CI，0.39-1.15])，复发性中风（OR，0.89[95%CI，0.57-1.38])，和复发性缺血性卒中(OR，1.09[95%CI，0.68-1.73]）在IVT和BMT组之间。IVT组和BMT组在早期神经功能恶化方面存在差异（OR，1.81[95%CI，1.17-2.80])，症状性颅内出血（OR，7.48[95%CI，3.55-15.76])，和出血性转化(或，4.73[95%CI，2.40-9.34]）。在非致残性缺陷的亚组患者或与使用抗血小板药物的患者相比，改良的Rankin量表评分为0至1的比较保持不变。
■这些研究结果表明，IVT并未显著改善急性轻微缺血性卒中患者的功能预后。此外,与BMT相比,它与有症状的颅内出血风险增加相关.此外，在非致残性缺陷或使用抗血小板的患者中，IVT可能不具有优于BMT的优势。
