2025 American Academy of Neurology Abstract Website

Mostafa Hossam El Din Moawad¹, Mohamed A. Alsaied², Ibrahim Serag², Ibraheem M Alkhawaldeh³, Abdallah Abbas⁴, Karim Abdelazim Abdelazim⁵, Ahmed Mostafa Amin⁶, Dalia Kamal Ewis⁷, Mohamed El-Moslemani⁴, Abdelfattah Arafa⁴, Mariam Elewidi⁸, Mohamed Elfil⁹, Mohamed Abouzid¹⁰, Seif Elhadidi¹¹, Ahmed Negida¹²
¹Alexandria Main University Hospital, Alexandria, Egypt, ²Faculty of Medicine, Mansoura University, ³Faculty of Medicine, Mutah University, Al-Karak-Jordan, ⁴Faculty of Medicine, Al-Azhar University, Damietta, Egypt, ⁵Department of Biotechnology, Institute of Graduate Studies and Research, Alexandria University, Alexandria, Egypt, ⁶Faculty of Medicine Al-azhar university, Cairo, Egypt., ⁷Faculty of medicine Beni Suef university, Beni Suef, Egypt, ⁸Faculty of Medicine Tanta University, ⁹University of Nebraska Medical Center, ¹⁰Department of Physical Pharmacy and Pharmacokinetics, Faculty of Pharmacy, Poznan University of Medical Sciences, ¹¹University of Hertfordshire, Egypt, ¹²Virginia Commonwealth University

Objective:

This study aims to evaluate the efficacy of different interventions for mild ischemic stroke by comparing their effects on posttreatment modified Rankin Scale (mRS) scores of 0-1 and 0-2 and posttreatment mortality rates

Background:

Mild ischemic stroke represents a significant portion of stroke cases, yet the optimal management strategies remain uncertain. Various interventions, including dual antiplatelet therapy (DAPT), single antiplatelet therapy (SAPT), intravenous thrombolysis (IVT), and anticoagulants, are employed to improve patient outcomes

Design/Methods:

A systematic, comprehensive literature search was conducted across various databases comparing the efficacy of different interventions for mild ischemic stroke. The study’s primary focus was on posttreatment mRS 0-1 and 0-2 performance and posttreatment mortality. A Bayesian network meta-analysis was conducted using R to assess the relative effect estimate of all interventions. Moreover, ranking of interventions was done using SUCRA scores to identify better options for management of mild ischemic stroke.

Results:

The treatment outcomes analysis revealed that for achieving a mRS score of 0-1, DAPT had a relative risk (RR) of 1.02 (95% CI [1.00–1.04]) compared to SAPT, while IVT showed an RR of 1.07 (95% CI [1.00–1.14]). The SUCRA scores ranked IVT highest (0.66) and SAPT lowest (0.21). For mRS 0-2, anticoagulants had the best outcome (RR=1.85, 95% CI [1.38–2.48], SUCRA score = 1.00). In mortality analysis, EVT ranked lowest in risk (SUCRA score = 0.85), while anticoagulants ranked last (0.44). DAPT showed the highest safety in complications (RR=0.24, 95% CI [0.15–0.38], SUCRA score = 1.00), and IVT (RR=12.60, 95% CI [1.67–95.00]) and EVT (RR=46.00, 95% CI [4.26–496.63]) had higher risks of symptomatic intracranial hemorrhage, with SAPT ranked safest (SUCRA score = 0.80).

Conclusions:

DAPT and IVT demonstrated favorable outcomes for achieving a mRS of 0-1, while anticoagulants were most effective for an mRS of 0-2. Notably, DAPT showed the highest safety in terms of complications.