The comparison of short-term outcome between tenecteplase and alteplase in minor acute ischemic stroke based on neutrophil-to-lymphocyte ratio stratification

This study aims to compare the effects of intravenous thrombolysis (IVT) with alteplase versus tenecteplase (TNK) on short-term outcomes in patients with minor acute ischemic stroke (AIS) across different levels of neutrophil-to-lymphocyte ratio (NLR). Patients with minor AIS (National Institutes of Health Stroke Scale [NIHSS] score ≤ 5) who underwent IVT were prospectively and consecutively enrolled. A total of 234 participants were included, among whom 86 (36.8%) received alteplase while 148 (63.2%) received TNK. At discharge, 158 (67.5%) patients achieved an excellent outcome [a modified Rankin Scale (mRS) of 0–1 point]. Using the median NLR value of 2.34 (1.64, 3.89), participants were stratified into a low-NLR group (NLR ≤ 2.34) and a high-NLR group (NLR > 2.34). In the low-NLR group, IVT with TNK was associated with an excellent outcome (OR = 3.44, 95% CI: 1.25–9.47, p = 0.017) but was not associated with an excellent outcome (OR = 1.93, 95% CI: 0.80–4.69, p = 0.14) in the high-NLR group. For patients with minor AIS within 4.5 h of onset, TNK may be considered a preferred option for IVT In the low-NLR subgroup.