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Meta-Analysis
. 2024 Sep;9(3):521-529.
doi: 10.1177/23969873241237312. Epub 2024 Mar 11.

Intravenous alteplase in minor nondisabling ischemic stroke: A systematic review and meta-analysis

Adel Alhazzani  1   2 , Fahad S Al-Ajlan  1   2 , Ahmed Alkhiri  3   4 , Ahmed A Almaghrabi  3   4 , Aser F Alamri  5   6 , Basil A Alghamdi  3   4 , Hassan K Salamatullah  3   4 , Abdullah R Alharbi  7 , Maher B Almutairi  3   4 , Hui-Sheng Chen  8 , Yongjun Wang  9 , Mohamad Abdalkader  10 , Guillaume Turc  11   12   13   14 , Pooja Khatri  15 , Thanh N Nguyen  10
Affiliations
Meta-Analysis

Intravenous alteplase in minor nondisabling ischemic stroke: A systematic review and meta-analysis

Adel Alhazzani et al. Eur Stroke J. 2024 Sep.

Abstract

Background: Minor ischemic stroke, defined as National Institute of Health Stroke Scale score of 0-5 on admission, represents half of all acute ischemic strokes. The role of intravenous alteplase (IVA) among patients with minor stroke is inconclusive; therefore, we evaluated clinical outcomes of these patients treated with or without IVA.

Materials and methods: We searched Medline, Embase, Scopus, and the Cochrane library until August 1, 2023. Inclusion was restricted to the English literature of studies that reported on minor nondisabling stroke patients treated with or without IVA. Odds ratios (ORs) with their corresponding 95% CIs were utilized using a random-effects model. Efficacy outcomes included rates of excellent (modified Rankin scale [mRS] of 0-1) and good (mRS of 0-2) functional outcome at 90 days. The main safety outcome was symptomatic intracerebral hemorrhage (sICH).

Results: Five eligible studies, two RCTs and three observational studies, comprising 2764 patients (31.8% female) met inclusion criteria. IVA was administered to 1559 (56.4%) patients. Pooled analysis of the two RCTs revealed no difference between the two groups in terms of 90-days excellent functional outcomes (OR 0.76 [95% CI, 0.51-1.13]; I2 = 0%) and sICH rates (OR 3.76 [95% CI, 0.61-23.20]). No significant differences were observed between the groups in terms of good functional outcomes, 90-day mortality, and 90-day stroke recurrence.

Conclusion: This meta-analysis of minor nondisabling stroke suggests that IVA did not prove more beneficial compared to no-IVA.

Keywords: Stroke; minor; thrombolysis.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Graphical abstract
Graphical abstract
Figure 1.
Figure 1.
Forest plots of (a) excellent functional outcome (mRS 0–1) at 90 days and (b) and good functional outcome (mRS 0–2) at 90 days.
Figure 2.
Figure 2.
Forest plots for (a) sICH, (b) mortality, and (c) stroke recurrence.
See this image and copyright information in PMC

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