• Acute ischemic stroke
• Efficacy
• Intracranial hemorrhage
• Safety
• Tissue Plasminogen Activator

• Humans
• Thrombolytic Therapy/methods
• Thrombolytic Therapy/adverse effects
• Fibrinolytic Agents/administration & dosage
• Fibrinolytic Agents/adverse effects
• Fibrinolytic Agents/therapeutic use
• Tissue Plasminogen Activator/administration & dosage
• Tissue Plasminogen Activator/adverse effects
• Tissue Plasminogen Activator/therapeutic use
• Ischemic Stroke/drug therapy
• Treatment Outcome
• Stroke/drug therapy
• Administration, Intravenous

• Universitätsklinikum RWTH Aachen (8915)

• clinical trial
• ischemic stroke
• tenecteplase
• thrombolytic therapy
• tissue plasminogen activator

• Humans
• Tenecteplase/adverse effects
• Tissue Plasminogen Activator/adverse effects
• Fibrinolytic Agents/adverse effects
• Ischemic Stroke/drug therapy
• Prospective Studies
• Retrospective Studies
• Brain Ischemia/drug therapy
• Stroke/drug therapy
• Intracranial Hemorrhages/chemically induced
• Treatment Outcome
• Randomized Controlled Trials as Topic

• NIHSS
• alteplase
• intravenous thrombolysis
• mild stroke
• non-disabling stroke

• minor stroke
• outcome
• stroke
• thrombolysis

• Z211100003521019 Beijing Municipal Science and Technology Commission
• PX2022019 Beijing Hospitals Authority
• 2020-1-2041 Capital's Funds for Health Improvement and Research
• 2019-I2M-5-029 Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences
• 81870905 National Natural Science Foundation of China
• U20A20358 National Natural Science Foundation of China
• 82171272 National Natural Science Foundation of China

• Stroke
• lipids
• neuroprotection
• prevention
• severity
• statins

• Ischemic stroke
• mild stroke
• outcomes

• onset to needle time
• posterior circulation stroke
• retrospective study
• rt-PA
• thrombolytic therapy

• Minor acute ischemic stroke
• Oral antiplatelet agents
• Stroke
• Tirofiban

• intracranial hemorrhage
• mRS
• meta-analysis
• minor ischemic stroke
• recombinant tissue plasminogen activator

• Fibrinolytic Agents/therapeutic use
• Humans
• Male
• Reperfusion/methods
• Retrospective Studies
• Stroke/drug therapy
• Thrombolytic Therapy/methods
• Tissue Plasminogen Activator/therapeutic use
• Treatment Outcome

• Mild ischemic stroke
• early neurological deterioration
• hemorrhagic transformation
• intravenous thrombolysis

• acute ischemic stroke
• prognosis
• rt-PA
• thrombolysis

To demonstrate the utility of Scale for the Assessment and Rating of Ataxia (SARA) for evaluation of posterior circulation-related features in patients with mild stroke.

Forty-five subjects, diagnosed with acute infarction in the cerebellum, basis pontis, thalamus, corona radiata, posterior limb of internal capsule, and their National Institutes of Health Stroke Scale (NIHSS) scores ≤5 were enrolled. SARA scores were graded by the cut-off value of severity in dependency of activities of daily living (ADL). SARA, Berg Balance Scale (BBS), Timed Up-and-Go (TUG), and Trunk Control Test (TCT) were correlated in regression analysis with the modified Rankin Scale (mRS) at discharge. Correlation between SARA and other tools was analyzed. Patients were divided based on mRS at admission (group A, mRS 0–2; group B, mRS 3–5). Scores between the two groups were compared.

Among the subjects, 48.9% (22/45) scored above 5.5 on SARA, and even 11.1% (5/45) scored higher than 14.25, which is the cut-off value of ‘severe dependency’ in ADL. SARA showed significant value for prediction of mRS at discharge. SARA was correlated with BBS (r=-0.946, p<0.001), TUG (r=-0.584, p<0.001), and TCT (r=-0.799, p<0.001). The SARA, BBS, TUG, and TCT scores between were lower in group B than in group A patients. SARA as well as BBS, TUG, and TCT reflect the functional severity of all patients.

SARA is a complementary tool for evaluation of the severity of ataxia in mild stroke patients with features of posterior circulation.

• Ataxia
• Scale for the Assessment and Rating of Ataxia
• Stroke

• Stroke
• cerebral infarction
• computed tomography perfusion
• diagnosis

• acute ischemic stroke
• factor VIII
• intracerebral hemorrhage
• therapy outcome
• thrombolysis
• von Willebrand factor

Thrombolysis treatment for patients with mild stroke is controversial. The aim of our study was to investigate whether patients with mild stroke or its specific etiologic subtype might benefit from rt-PA therapy. Data were derived from two cohorts of patients with and without rt-PA treatment: (1) the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China) and (2) the China National Stroke Registry (CNSR) database. Patients with mild stroke (defined as National Institutes of Health Stroke Scale ≤5) receiving the rt-PA therapy and without rt-PA therapy were matched in 1:2 for age, sex, stroke severity and etiologic subtype. A total of 134 rt-PA-treated patients were matched to 249 non-rt-PA-treated patients in the study. Among them, 104 (76%) rt-PA-treated patients with mild stroke had good outcome after 3 months compared with 173 (69.5%) non-rt-PA-treated matching cases (odds ratio [OR], 1.48; 95% confidence interval [CI], 0.91–2.43; P = 0.12). Compared with non-rt-PA-treated group, rt-PA-treated patients had good outcome after 3 months in those with stroke subtype of large-artery atherosclerosis (LAA) (80.5% vs 65.1%; OR, 2.19; 95%CI, 1.14–4.21; P = 0.02). For patients with mild stroke, intravenous rt-PA treatment may be effective. Patients with stroke subtype of LAA might benefit more from rt-PA treatment.

• ischemic stroke
• long-term survival
• thrombolysis

• acute ischemic stroke
• ischemic stroke etiology
• prognosis
• stroke MRI
• tissue plasminogen activator

The NOR-SASS (Norwegian Sonothrombolysis in Acute Stroke Study) aimed to assess effect and safety of contrast-enhanced ultrasound treatment in an unselected acute ischemic stroke population.

Patients treated with intravenous thrombolysis within 4.5 hours after symptom onset were randomized 1:1 to either contrast-enhanced sonothrombolysis (CEST) or sham CEST. A visible arterial occlusion on baseline computed tomography angiography was not a prerequisite for inclusion. Pulse-wave 2 MHz ultrasound was given for 1 hour and contrast (SonoVue) as an infusion for ≈30 minutes. Magnetic resonance imaging and angiography were performed after 24 to 36 hours. Primary study end points were neurological improvement at 24 hours defined as National Institutes of Health Stroke Scale score 0 or reduction of ≥4 National Institutes of Health Stroke Scale points compared with baseline National Institutes of Health Stroke Scale and favorable functional outcome at 90 days defined as modified Rankin scale score 0 to 1.

A total of 183 patients were randomly assigned to either CEST (93 patient) or sham CEST (90 patients). The rates of symptomatic intracerebral hemorrhage, asymptomatic intracerebral hemorrhage, or mortality were not increased in the CEST group. Neurological improvement at 24 hours and functional outcome at 90 days was similar in the 2 groups both in the intention-to-treat analysis and in the per-protocol analysis.

CEST is safe among unselected ischemic stroke patients with or without a visible occlusion on computed tomography angiography and with varying grades of clinical severity. There was, however, statistically no significant clinical effect of sonothrombolysis in this prematurely stopped trial.

URL: http://www.clinicaltrials.gov. Unique identifier: NCT01949961.

• angiography
• brain
• randomized controlled trial
• safety
• stroke

We sought to assess the safety, effectiveness and cost of 0.6 mg/kg rt-PA treatment for patients with acute mild stroke and to compare that with 0.9 mg/kg. We retrospectively analyzed consecutive acute ischemic stroke patients who had a NIHSS score ≤5 at admission and who were treated with rt-PA within 4.5 hours of symptom onset. The demographic data, clinical outcomes and hospitalization cost were analyzed. A total of 108 patients were included. Forty six patients (42.6%) received a 0.6 mg/kg dosage of rt-PA. The baseline characteristics of the two groups were well matched (p > 0.05). Regarding the safety and effectiveness, the 0.6 mg/kg dosage group had a comparable proportion of symptomatic intracranial hemorrhage (sICH) (0.6 mg/kg, 4.3% vs 0.9 mg/kg, 4.8%; p > 0.05), early neurological deterioration (END) (19.6% vs 17.7%; p > 0.05), in-hospital mortality (4.3% vs 1.6%; p > 0.05), and a similar rate of favorable functional outcome (mRS score 0–1) at 3 months (73.9% vs 71.0%; p > 0.05) to those who received the standard dosage. However, the hospital cost was markedly lower in the 0.6 mg/kg group (0.6  mg/kg, 3,401.7 USD vs 0.9  mg/kg, 4,157.4 USD; p < 0.01). Our study suggest that 0.6 mg/kg rt-PA shared similar effectiveness and safety profile compared with that of 0.9 mg/kg in treating mild stroke, but cost less.

The burden of stroke on healthcare services in sub‐Saharan Africa (SSA) is increasing. However, long‐term outcomes from stroke in SSA are not well described. We aimed to investigate case‐fatality and health outcomes for stroke survivors at 7‐ to 10‐year follow‐up.

The Tanzanian Stroke Incidence Project (TSIP) recruited incidence stroke cases between 2003 and 2006. We followed up cases in 2013, recording date of death in those who had died.

Of 130 stroke cases included in this study, case‐fatality and date of death data were available for 124 at 7–10 years post‐stroke. Of these, 102 (82.3%) had died by 7 years post‐stroke. Functional disability, as measured by the Barthel index immediately post‐stroke, was a significant predictor of case‐fatality at seven‐year follow‐up with those with severe disability having an almost four‐fold increase in the odds of death compared with those with no, mild or moderate disability.

Case‐fatality rates are higher than reported in high‐income countries, with post‐stroke disability a significant predictor of death. Sustainable interventions to reduce post‐stroke disability in this setting should be investigated.

• Tanzania
• case-fatality
• disability
• mortality
• stroke
• sub-Saharan Africa

• CEREBROVASCULAR DISEASE
• SCALES
• STROKE

The term “mild stroke”, or “minor stroke” refers to the acute ischemic stroke patients with mild and nondisabling symptoms. Currently there is still no unanimous consensus on the exact definition of mild stroke. Patients with mild stroke are assumed to have a good prognosis in natural course, so they are routinely not given thrombolysis despite early emergency department arrival. Recent studies have revealed that, however, approximately one third of so-called mild stroke patients who are not treated with thrombolysis have significant disability whereas those treated are more likely to achieve a good recovery. Thus excluding all mild strokes from thrombolysis is probably not justified. Those mild stroke patients who are likely to experience early deterioration or end with disability are mostly characterized by imaging findings. Therefore, selected patients with these characteristics based on neuroimaging to be given thrombolysis might be more justified. Meanwhile, new definition should be developed to exclude those who are at a higher risk of poor outcome. Applying information from imaging may make it come true. Using neuroimaging information to define mild stroke and select patients with mild symptoms to thrombolysis may be a future direction.

• Definition
• Mild stroke
• Minor stroke
• Neuroimaging
• Thrombolysis

Mild deficit is a relative contraindication to administration of IV rtPA for acute ischemic stroke. However, what constitutes “mild” deficit is vague. Prior studies showed patients with mild strokes have substantial disability rates at hospital discharge and at 90 days. We investigated whether the application of a new definition altered the rates of disability overall, and assessed the effects of thrombolysis.

This analysis included all adult acute ischemic stroke patients from a prospective registry of consecutive patients (UCSD SPOTRIAS database, 2003-2014) with 90-day mRS score available who were defined as “mild” using either: NIHSS 0-5 or a TREAT Task Force definition (NIHSS 0-5 and non-disabling based on pre-specified syndromes). Dichotomized 90-day mRS were compared between treated and untreated patients using the two definitions.

Of 802 ischemic stroke patients with mRS scores available, 184 had baseline mRS(0) and met TREAT criteria; 45(24.5%) were rtPA-treated. Among treated patients, 35.6% had 90-day mRS(2-6), versus 28.8% in the untreated group, a non-significant difference after adjusting for baseline NIHSS (p=0.47). None of the 45 treated patients had symptomatic hemorrhage. Outcomes were similar using the simpler NIHSS 0-5 definition.

About one-third of mild stroke patients were not functionally independent at 90 days, irrespective of treatment or mild definition applied, calling into question the treatment efficacy of IV rtPA for mild strokes as well as what constitutes an appropriate definition of “mild”. Randomized studies are necessary to determine rtPA treatment efficacy in mild stroke patients.

• Acute stroke
• functional outcomes
• mild stroke
• stroke outcomes
• thrombolysis
• thrombolytic treatment exclusion

• Aged
• Brain Ischemia/complications
• Brain Ischemia/drug therapy
• Brain Ischemia/mortality
• Databases, Factual
• Female
• Fibrinolytic Agents/administration & dosage
• Follow-Up Studies
• Humans
• Infusions, Intravenous
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Odds Ratio
• Registries
• Retrospective Studies
• Risk Assessment
• Severity of Illness Index
• Stroke/drug therapy
• Stroke/etiology
• Stroke/mortality
• Survival Rate
• Thrombolytic Therapy/methods
• Time Factors
• Treatment Outcome

One third of patients presenting with initially mild strokes have unfavorable outcomes, and the efficacy of intravenous thrombolysis (IVT) in this population has not been proven. This study aimed to evaluate the comparative effectiveness of standard care with IVT versus without IVT in mild stroke patients.

Using a multicenter stroke registry database, we identified patients with acute ischemic stroke who presented within 4.5 hours of symptom onset and had initial National Institutes of Health Stroke Scale scores ≤5. Multivariable logistic analysis and propensity score matching were used to adjust for baseline imbalances between the patients who did and did not receive IVT. Adjusted odds ratios and 95% CIs of IVT were estimated for 3‐month modified Rankin Scale scores of 0 to 1 and symptomatic. Of 13 117 patients with stroke who were hospitalized between April 2008 and May 2012, 1386 met the eligibility criteria, and 194 (14.0%) were treated with IVT. For a modified Rankin Scale of 0 to 1 at 3 months, the adjusted odds ratios were 1.96 (95% CI, 1.28 to 3.00; P=0.002) by multivariable logistic analysis and 1.68 (1.10 to 2.56; P=0.02) by propensity score matching analysis, respectively. There was a statistically nonsignificant excess of symptomatic hemorrhagic transformation (odds ratios=3.76 [0.95 to 16.42; P=0.06] and 4.81 [0.84 to 49.34; P=0.09]), respectively.

In this observational registry‐based study, standard care with IVT is more effective than not receiving IVT in mild ischemic stroke patients, and there is a statistically nonsignificant risk of symptomatic hemorrhagic transformation.

• Aged
• Brain Ischemia/complications
• Brain Ischemia/drug therapy
• Brain Ischemia/mortality
• Databases, Factual
• Female
• Fibrinolytic Agents/administration & dosage
• Follow-Up Studies
• Humans
• Infusions, Intravenous
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Odds Ratio
• Registries
• Retrospective Studies
• Risk Assessment
• Severity of Illness Index
• Stroke/drug therapy
• Stroke/etiology
• Stroke/mortality
• Survival Rate
• Thrombolytic Therapy/methods
• Time Factors
• Treatment Outcome