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Background <p>Patients with mild stroke (National Institutes of Health Stroke Scale [NIHSS] ≤ 5) and severe intracranial stenosis or occlusion represent a high-risk subgroup for early neurological deterioration (END) and are strong predictors of poor 3-month functional outcomes. The effectiveness of intravenous thrombolysis (IVT) in patients with minor stroke and large vessel severe stenosis or occlusion (LVSSO) remains uncertain. This study aims to assess the comparative efficacy and safety of IVT versus standard medical therapy (SMT) through a systematic review and meta-analysis of both randomized and observational studies.</p> Methods <p>A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was conducted to identify studies evaluating IVT in minor stroke with LVSSO from database inception through March 13, 2025. The primary outcome was defined as an excellent functional outcome (modified Rankin Scale [mRS] 0–1) at 90&#xa0;days. Pooled analyses were performed using odds ratios (ORs) with 95% confidence intervals (CIs) for the overall population and prespecified subgroups. The study protocol was prospectively registered in the PROSPERO international registry (CRD42025637459).</p> Results <p>A total of five studies were included, comprising 1090 patients with mild ischemic stroke and LVSSO treated with IVT and 3501 patients treated with SMT. Compared with SMT, IVT significantly improved the 90-day excellent functional outcome (mRS 0–1) (OR, 1.58 [95% CI, 1.16–2.15]). In the large vessel occlusion subgroup, IVT was also significantly associated with an excellent 90-day functional outcome (OR, 1.52 [95% CI, 1.03–2.23]). No significant differences were observed between groups in 90-day favorable functional outcome (mRS 0–2), symptomatic intracranial hemorrhage (sICH), 90-day mortality, or 90-day stroke recurrence.</p> Conclusions <p>These findings suggest that IVT may be associated with improved 90-day excellent functional outcomes in patients with mild acute ischemic stroke (AIS) and LVSSO, without increasing the risk of sICH.</p>

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Intravenous thrombolysis versus standard medical therapy in minor stroke patients with large vessel severe stenosis or occlusion: a systematic review and meta-analysis

  • 期刊论文

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  • 发表日期：

    2026年3月6日

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  • Tianhao Zhang,
  • Lin Tong,
  • Luyao Xu,
  • Ruhui Liu,
  • Liwen Xie,
  • Li Jiang,
  • Minghui Du,
  • Hanye Yuan,
  • Zhigang Liang

摘要

Background

Patients with mild stroke (National Institutes of Health Stroke Scale [NIHSS] ≤ 5) and severe intracranial stenosis or occlusion represent a high-risk subgroup for early neurological deterioration (END) and are strong predictors of poor 3-month functional outcomes. The effectiveness of intravenous thrombolysis (IVT) in patients with minor stroke and large vessel severe stenosis or occlusion (LVSSO) remains uncertain. This study aims to assess the comparative efficacy and safety of IVT versus standard medical therapy (SMT) through a systematic review and meta-analysis of both randomized and observational studies.

Methods

A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was conducted to identify studies evaluating IVT in minor stroke with LVSSO from database inception through March 13, 2025. The primary outcome was defined as an excellent functional outcome (modified Rankin Scale [mRS] 0–1) at 90 days. Pooled analyses were performed using odds ratios (ORs) with 95% confidence intervals (CIs) for the overall population and prespecified subgroups. The study protocol was prospectively registered in the PROSPERO international registry (CRD42025637459).

Results

A total of five studies were included, comprising 1090 patients with mild ischemic stroke and LVSSO treated with IVT and 3501 patients treated with SMT. Compared with SMT, IVT significantly improved the 90-day excellent functional outcome (mRS 0–1) (OR, 1.58 [95% CI, 1.16–2.15]). In the large vessel occlusion subgroup, IVT was also significantly associated with an excellent 90-day functional outcome (OR, 1.52 [95% CI, 1.03–2.23]). No significant differences were observed between groups in 90-day favorable functional outcome (mRS 0–2), symptomatic intracranial hemorrhage (sICH), 90-day mortality, or 90-day stroke recurrence.

Conclusions

These findings suggest that IVT may be associated with improved 90-day excellent functional outcomes in patients with mild acute ischemic stroke (AIS) and LVSSO, without increasing the risk of sICH.