Article Figures & Data
Tables
- Table 1
Different definitions of minor stroke in different studies
Definitions Study (A) All patients with a score 0 or 1 on every baseline NIHSS score item, except level of consciousness items (items 1a to 1c), which must be 0. EXPRESS27 (B) All patients with a lacunar-like syndrome (presumed small-vessel occlusive disease) such as pure sensory syndrome, pure motor hemiparesis, sensorimotor syndrome, ataxic hemiparesis and dysarthria-clumsy hand syndrome. TOAST28 (C) Baseline NIHSS in the lowest (least severe) quartile of severity (NIHSS≤9). DATAS II29 (D) Baseline NIHSS≤3. CHANCE,13 CHANCE 2,30 POINT14 (E) Baseline NIHSS 0–5. SOCRATES,31 THALES,32 PRISMS,15 INSPIRES16 (F) Baseline NIHSS≤5, with 1 point on the NIHSS in several key single-item scores, such as vision, language, neglect or single limb weakness, and a score of 0 in the consciousness item. ARAMIS18 ARAMIS, Antiplatelet vs R-tPA for Acute Mild Ischemic Stroke.; CHANCE 2, Clopidogrel with Aspirin in High-Risk Patients with Acute Nondisabling Cerebrovascular Events II; CHANCE, Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events; DATAS II, Dabigatran Treatment of Acute Stroke II; EXPRESS, Early use of EXisting PREventive Strategies for Stroke; INSPIRES, Intensive Statin and Antiplatelet Therapy for Acute High-Risk Intracranial or Extracranial Atherosclerosis; NIHSS, National Institutes of Health Stroke Scale; POINT, Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke; PRISMS, Potential of r-tPA for Ischemic Strokes With Mild Symptoms; SOCRATES, Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes; THALES, Acute Stroke or Transient Ischemic Attack Treated With Ticagrelor and ASA for Prevention of Stroke and Death; TOAST, Trial of Org 10172 in Acute Stroke Treatment .
- Table 2
Comparison of guidelines recommendation on minor stroke and level of evidence
Guidelines Recommendation COR/LOE Chinese Stroke Association 2023 For patients with acute ischaemic stroke with mild and disabling symptoms within 4.5 hours of onset, intravenous thrombolysis is recommended. IIa/B For patients with acute ischaemic stroke with mild non-disabling symptoms (NIHSS 0–5) within 4.5 hours, intravenous thrombolysis is not routinely recommended. III/B For patients with minor ischaemic stroke and high-risk transient ischaemic attack who did not receive intravenous thrombolysis, dual antiplatelet therapy is initiated within 24 hours of symptom onset if their NIHSS score is <3. I/A For patients with moderate ischaemic stroke (NIHSS score of 4–5) who present within 24 hours of symptom onset, ticagrelor plus aspirin for 30 days (ticagrelor loading dose of 180 mg on the first day, followed by 90 mg two times per day) may reduce the risk of recurrent stroke and death within 30 days. IIb/B American Stroke Association 2019 For otherwise eligible patients with mild stroke presenting in the 3-hour to 4.5-hour window, treatment with intravenous alteplase may be reasonable. Treatment risks should be weighed against possible benefits. IIb/B European Stroke Organisation (ESO) 2023 For patients with acute minor, disabling ischaemic stroke of <4.5-hour duration, we recommend intravenous thrombolysis with alteplase. Moderate,strong For patients with acute minor non-disabling ischaemic stroke of <4.5-hour duration, we suggest no intravenous thrombolysis. Moderate, weak For patients with acute minor non-disabling ischaemic stroke of <4.5-hour duration, and with proven large-vessel occlusion, there is insufficient evidence to make an evidence-based recommendation. Very low For patients with acute minor non-disabling ischaemic stroke of <4.5-hour duration, and with proven large-vessel occlusion, there is insufficient evidence to make an evidence-based recommendation. Expert consensus For patients with acute ischaemic stroke of <4.5-hour duration, and rapidly improving neurological signs, which are still disabling, there is insufficient evidence to make a recommendation. Very low For patients with acute ischaemic stroke of <4.5-hour duration, and rapidly improving neurological signs, which are still disabling, intravenous thrombolysis with alteplase is recommended. Expert consensus COR, Classification of recommendation; LOE, Level of Evidence; NIHSS, National Institutes of Health Stroke Scale.
