Prevalence and outcomes of mild stroke patients undergoing reperfusion therapy: A meta-analysis and SAFE recommendations for optimal management

Mild strokes, which affect millions of people worldwide, are often less severe but can still cause long-term disabilities. This study examined treatments commonly used for stroke patients, such as intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT). These treatments aim to restore blood flow to the brain after a stroke, but their effectiveness in mild stroke cases is not well understood. The study analyzed data from 56 studies involving nearly 475,000 stroke patients and found that mild strokes accounted for over half of all stroke cases. However, only a small percentage of patients with mild strokes received IVT (29%) or EVT (9%). The results showed that these treatments increased the risk of serious complications, such as brain bleeding and early neurological decline. Despite these risks, the treatments did not significantly improve patients' chances of full recovery, reduce the risk of death, or prevent future strokes. Based on these findings, the authors propose a decision-making framework called "SAFE" for treating mild strokes. This framework emphasizes selective use of IVT based on patient-specific risks, assessment of EVT only for certain severe cases, focus on individual patient profiles, and ensuring adherence to regional guidelines. The study underscores the urgent need for more research to identify safer and more effective treatments for mild strokes.