Catalan Stroke Code and Reperfusion Consortium (Cat-SCR Consortium)
To analyze the factors that determine the treatment with intravenous thrombolysis (IVT) in patients with minor ischemic stroke (NIHSS ≤ 5) in our population.
Data were obtained from CICAT: prospective, government-mandated, population-based registry of stroke code patients in Catalonia. We selected patients diagnosed with ischemic stroke and NIHSS ≤ 5 at hospital admission from January 2016 to October 2020. We excluded patients with a baseline modified Rankin scale(mRS) ≥ 3, absolute contraindication for IVT, unknown stroke onset or admitted to hospital beyond 4.5 h.
We analyzed 2868 patients, 1396 (48.7%) received IVT, 22(1.6%) had a symptomatic hemorrhagic transformation. Patients treated with IVT were younger (68 vs 69 years, p=0.037), more frequently women (53% vs 47%, p = 0.001), had higher NIHSS (4 vs 2, p=0.001), arrived earlier to hospital (81 vs 91 min, p=0.001) and had more large vessel occlusion (LVO, 13% vs 2% p < 0.001). For NIHSS 4-5, 2-3 and 0-1, the proportion of patients treated with IVT and mean door-to-needle time were respectively: 85%/41%/16% p<0.001 and 48/51/58 min p=0.003. In adjusted multivariate analysis NIHSS (OR 2.7 CI 95% 2.5-2.9) and LVO(OR 10.3 CI 95% 6.5-16.4) were the variables more strongly associated with IVT. The effect of LVO was more important in patients with NIHSS 0-1(OR 17.7 CI95% 7.7-40.9) and NIHSS 2-3(OR 8.9 CI 4.9-16.4) than NIHSS 4-5(OR 3.6 CI95% 1.4- 9.1).
NIHSS and LVO were strong predictors for IVT in minor stroke patients. The effect of diagnosing LVO was more important in patients with low NIHSS