title: Thrombolysis for Acute Minor Stroke: Outcome and Barriers to Management. Results from the RESUVAL Stroke Network.
abstract: BACKGROUND
  We evaluated the management, outcome and haemorrhagic risk in a cohort of ischaemic stroke patients with mild symptoms treated with intravenous tissue plasminogen activator (tPA) within the first 4.5 h.
  
  
  METHODS
  We analysed data from a prospective stroke thrombolysis registry. A total of 1,043 patients received tPA between 2010 and 2014 in the 5 stroke units of the RESUVAL stroke network (Rhône Valley, France). Among them, 170 patients had a National Institute of Health Stroke Scale (NIHSS) score ≤4 (minor group: MG) before tPA and 873 patients had a NIHSS score >4.
  
  
  RESULTS
  A high rate (77%) of excellent outcome (3-month-modified Rankin Scale score ≤1) was observed in the MG. No symptomatic intracerebral haemorrhage occurred and the rate of any haemorrhagic transformation was 5%. Fifty-four percent of the MG patients had visible arterial occlusion before tPA. Patients of the MG were less likely to be transported by Emergency Medical Services and to be directly admitted to the stroke unit or to imaging. Median delays from onset to admission, from admission to imaging and from onset to tPA were longer in the MG.
  
  
  CONCLUSIONS
  Our data provided evidence of safety and suggested potential benefit of thrombolysis in patients with NIHSS score ≤4. A majority of these patients exhibited arterial occlusion before thrombolysis. Most often, patients with mild stroke are not given priority in terms of the mode of transport, direct admission to stroke unit and rapid imaging, resulting in an increased delay from onset to thrombolysis. Health system improvements are needed to provide all suspected stroke victims equal access to imaging and treatment on an emergency basis.
authors.affiliation: Department of Neurology, Stroke Unit, Neurological Hospital, University of Lyon, Lyon, France.
authors.forename: Chloé
authors.initials: C
authors.lastname: Laurencin
authors.forename: Frédéric
authors.initials: F
authors.lastname: Philippeau
authors.forename: Karine
authors.initials: K
authors.lastname: Blanc-Lasserre
authors.forename: Anne-Evelyne
authors.initials: AE
authors.lastname: Vallet
authors.forename: Serkan
authors.initials: S
authors.lastname: Cakmak
authors.forename: Laura
authors.initials: L
authors.lastname: Mechtouff
authors.forename: Tae-Hee
authors.initials: TH
authors.lastname: Cho
authors.forename: Thomas
authors.initials: T
authors.lastname: Ritzenthaler
authors.forename: Elodie
authors.initials: E
authors.lastname: Flocard
authors.forename: Magali
authors.initials: M
authors.lastname: Bischoff
authors.forename: Carlos
authors.initials: C
authors.lastname: El Khoury
authors.forename: Norbert
authors.initials: N
authors.lastname: Nighoghossian
authors.forename: Laurent
authors.initials: L
authors.lastname: Derex
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000139:chemically induced; D003952:Diagnostic Imaging / Q000379:methods; D004185:Disability Evaluation; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D005602:France; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D014187:Transportation of Patients; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator