Abstract Body: Introduction: Thrombolytic therapy has been a standard part of treatment of large vessel occlusion acute ischemic strokes. There is, however, insufficient evidence in literature to draw significant conclusions as to the efficacy of different thrombolytic agents with extremes of age (elderly or young) in minor stroke patients. The objective is to describe rates of clinical improvement of patients with minor stroke with various thrombolytic agents across ages.
Methods: A registry of acute ischemic stroke patients between 1/2017 - 9/2023 was retrospectively reviewed. Patients with National Institutes of Health Stroke Scale (NIHSS) score less than or equal to 5 were included. Multivariable age-adjusted logistic regression for the effect of thrombolysis, and the type of thrombolytic agent used, on the likelihood of improvement in NIHSS by 24 hours was performed. Margins plots were derived from regression analyses.
Results: Of 1257 patients with minor stroke, median age was 67 years (IQR 58-76). Median NIHSS on admission was 2 (IQR 0-3), with 29.0% (365/1257) of patients experiencing improvement by 24 hours. Thrombolytics were administered in 9.5% (119/1257). In a multivariable regression, there was a significant interaction effect between age and thrombolytics (p=0.01). Thrombolytics were associated with significantly higher odds of NIHSS improvement (p=0.004). Between the types of thrombolytic agents used, there was a significant interaction effect between age and tenecteplase (p=0.02). In contrast, there was not a significant interaction between age and tissue plasminogen activator (p=0.08). In prediction models, the odds of NIHSS improvement in thrombolytic-treated patients were above 50% for patients less than 70 years. Odds of NIHSS improvement in tenecteplase-treated patients were above 50% for patients less than 60 years old.
Conclusion: There is an age-dependent effect on the benefit of thrombolytics, specifically tenecteplase, administration for stroke symptom improvement. Although recent studies show neutral or mixed outcomes using thrombolytics in minor strokes, certain subpopulations, such as young patients, may benefit from this intervention. Future studies may elucidate minor stroke subpopulations potentially benefiting from acute thrombolytic treatment.