Intravenous thrombolysis for minor stroke and rapidly improving symptoms: a quantitative overview.

Minor stroke and rapidly improving symptoms (MRIS) are usually excluded from intravenous thrombolysis (IVT) considering a possible benign prognosis and potential bleeding risk. However, its risk-benefit profile from IVT has not been fully illustrated. We searched PubMed for articles published up to December 2013 and included papers focused on the functional outcome of MRIS after IVT. The primary analysis was a comparison of the prognosis of MRIS after IVT versus non-minor stroke with IVT and MRIS without IVT, respectively. For safety analysis, the rates of symptomatic intracranial hemorrhage (SICH) and mortality were compared. Statistic calculation was conducted using the RevMan5.1 software. A total of 13 citations encompassing 2905 MRIS cases were included. Favorable discharge outcome was more frequent in non-thrombolysed MRIS than thrombolysed MRIS with an odds ratio (OR) of 0.50 (95 % CI, 0.25-0.97), while no difference was noted in the outcome after 3 months (OR 0.99; 95 % CI, 0.74-1.34). Compared with non-minor stroke, MRIS had nearly 4 times more chance to have a favorable 3-month outcome after IVT, accompanied with a lower rate of SICH (pooled rate, 3.68 % versus 5.77 %; OR 0.57; 95 % CI, 0.39-0.84). Mortality was not significantly different for MRIS with or without IVT (OR 1.21; 95 % CI, 0.54-2.72) in the included population, but was still much less than non-minor stroke after IVT (OR 0.16; 95 % CI, 0.09-0.31). MRIS patients seem not to benefit from IVT in the short-term and 3-month outcomes due to increasing early hazards. Compared with non-minor stroke, MRIS with IVT suffers a significantly lower risk of SICH and death.