ABSTRACT NUMBER: ESOC2026A1143 OUTCOMES AND SAFETY OF INTRAVENOUS THROMBOLYSIS IN MINOR ISCHAEMIC STROKE (NIHSS 0–5): A RETROSPECTIVE COHORT STUDY

Abstract Background and aims The benefit-risk profile of intravenous thrombolysis (IVT) in minor ischaemic stroke remains controversial. We evaluated real-world outcomes and safety of IVT in a centre with liberal thrombolysis policy. Methods We performed a retrospective cohort study of consecutive IVT-treated patients with minor ischaemic stroke (admission NIHSS 0–5) at Stavanger University Hospital between 2003 and 2023. Patients were stratified into NIHSS 0–2 and NIHSS 3–5 groups. Outcomes included early neurological improvement (NIHSS 0–1 within 24 hours), functional independence at 90 days (mRS 0–2), poor outcome (mRS 4–6), and symptomatic intracranial haemorrhage (sICH). In confirmed stroke cases, excluding stroke mimics, multivariable binary logistic regression analyses adjusted for age, sex, vascular risk factors, and treatment times were performed. Results Among 2008 IVT-treated patients, 1270 (63%) had admission NIHSS 0-5: 744 (59%) NIHSS 0-2 and 526 (41%) NIHSS 3-5. Stroke mimics were more frequent in the NIHSS 0-2 group (29% versus 22%). Compared with NIHSS 3-5, confirmed stroke patients with NIHSS 0-2 had higher odds of early neurological improvement (OR 3.99 95% CI 2.82-5.66), functional independence (OR 1.32 95% CI 1.00-1.73) and lower odds of poor outcomes (OR 0.330 95% CI 0.152-0.714). In the analysed cohort, there were four cases of sICH (< 1%). Conclusions In a liberal use setting, IVT in patients with NIHSS 0–2 was associated with favourable functional outcomes and low complications rates. These findings support continued evaluation of IVT in carefully selected patients with mild deficits. Conflict of interest Nedim Leto: nothing to disclose Soffien Ajmi: nothing to disclose Christopher Munk: nothing to disclose Elisabeth Farbu: nothing to disclose Thomas Lindner: nothing to disclose Martin Kurz: nothing to disclose