Evaluating Alteplase Use in Minor Ischemic Stroke: Insights from a Nationwide Chinese Registry

Background

Minor ischemic stroke presents a therapeutic dilemma in acute stroke management. While thrombolytic therapy with intravenous alteplase is established for moderate to severe ischemic stroke, its benefit in patients with minor stroke remains uncertain. Minor ischemic strokes, often defined by a National Institutes of Health Stroke Scale (NIHSS) score of 5 or less, represent a heterogeneous group with varying potential for disability. Determining which patients with minor stroke may benefit from alteplase is critical, as the risk-to-benefit ratio must be carefully weighed given the risk of hemorrhagic complications.

In clinical practice, defining “disabling” minor stroke is controversial, leading to varied treatment approaches worldwide. Some minor strokes that affect motor function, speech, or consciousness can cause considerable disability despite low NIHSS scores. The Third China National Stroke Registry (CNSR-III) provides a robust prospective dataset to explore the real-world effectiveness and safety of alteplase in this population.