{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T10:02:30Z","timestamp":1771927350117,"version":"3.50.1"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Mild non-disabling ischemic stroke (MNDIS) is increasingly treated with intravenous thrombolysis, yet a substantial proportion of patients still experience poor functional outcomes, and robust tools for individualized risk prediction are lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this retrospective cohort study, we analyzed 713 consecutive MNDIS patients who received intravenous thrombolysis within 4.5\u202fh of symptom onset at an advanced stroke center between January 1, 2022 and December 31, 2024. Poor outcome was defined as a 90-day modified Rankin Scale (mRS) score \u22652. Candidate predictors, including demographic, clinical, laboratory, hemodynamic and imaging variables, were first screened by univariable analysis and then entered into a stepwise multivariable logistic regression model (entry\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05, removal\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;gt;\u202f0.10). A nomogram incorporating independent predictors was constructed in R, and its performance was evaluated using receiver operating characteristic (ROC) analysis, bootstrap calibration, and decision curve analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 713 patients, 91 (12.8%) had poor 90-day outcomes (mRS 2\u20136) and 622 (87.2%) had good outcomes (mRS 0\u20131). Admission NIHSS score (OR 1.37; 95% CI 1.10\u20131.72), 24-h NIHSS score (OR 1.78; 95% CI 1.52\u20132.10), diastolic blood pressure (OR 1.02 per mmHg; 95% CI 1.00\u20131.05), and coronary heart disease (OR 1.88; 95% CI 1.05\u20133.35) were independently associated with poor outcome. The resulting nomogram showed good discrimination (AUC 0.835; 95% CI 0.805\u20130.861; sensitivity 71.4%; specificity 84.1%), excellent calibration (bootstrap mean absolute error 0.014), and provided positive net clinical benefit across a wide range of risk thresholds (0.03\u20130.89).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Admission and 24-h NIHSS scores, diastolic blood pressure, and coronary heart disease are key predictors of poor 90-day outcomes after thrombolysis in patients with MNDIS. The derived nomogram offers accurate, well-calibrated, and clinically useful individualized risk estimation, and may assist clinicians in early post-thrombolysis risk stratification and tailoring the intensity of monitoring and follow-up.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1754895","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T06:48:36Z","timestamp":1769150916000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Development of a prediction model for poor outcomes after thrombolysis in mild non-disabling ischemic stroke"],"prefix":"10.3389","volume":"17","author":[{"given":"Xiaopan","family":"Cao","sequence":"first","affiliation":[{"name":"Department of Neurology VIII, Shenyang First People\u2019s Hospital","place":["Shenyang, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhijian","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Neurology VIII, Shenyang First People\u2019s Hospital","place":["Shenyang, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurology I, Shenyang First People\u2019s Hospital","place":["Shenyang, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Neurology VIII, Shenyang First People\u2019s Hospital","place":["Shenyang, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yang","family":"Jiang","sequence":"additional","affiliation":[{"name":"Neurology Outpatient Department, Shenyang First People\u2019s Hospital","place":["Shenyang, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xue","family":"Cong","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Shenyang First People\u2019s Hospital","place":["Shenyang, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bing","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Shenyang Tenth People\u2019s Hospital","place":["Shenyang, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurorehabilitation, Shenyang First People\u2019s Hospital","place":["Shenyang, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e67","DOI":"10.1161\/CIR.0000000000000558","article-title":"Heart disease and stroke statistics-2018 update: a report from the American Heart Association","volume":"137","author":"Benjamin","year":"2018","journal-title":"Circulation"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1007\/s40472-024-00428-6","article-title":"Mitochondrial transplantation in ischemic stroke: insights from a first-in-human brain trial","volume":"11","author":"Walker","year":"2024","journal-title":"Curr Transplant Rep"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/s13073-023-01273-5","article-title":"Novel functional insights into ischemic stroke biology provided by the first genome-wide association study of stroke in indigenous Africans","volume":"16","author":"Akinyemi","year":"2024","journal-title":"Genome Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"2555","DOI":"10.1016\/j.jtha.2024.05.034","article-title":"Association between thrombus composition and first-pass recanalization after thrombectomy in acute ischemic stroke","volume":"22","author":"Vandelanotte","year":"2024","journal-title":"J Thromb Haemost"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"89","DOI":"10.69854\/jcq.2024.0012","article-title":"The effectiveness and safety of adjuvant therapy with t-PA in acute ischemic stroke: a systematic review and network meta-analysis","volume":"1","author":"Zhen","year":"2024","journal-title":"J Clin Question"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e031692","DOI":"10.1161\/JAHA.123.031692","article-title":"Comprehensive review of tenecteplase for thrombolysis in acute ischemic stroke","volume":"13","author":"Wang","year":"2024","journal-title":"J Am Heart Assoc"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"839","DOI":"10.1038\/s41597-024-03667-5","article-title":"The stroke outcome optimization project: acute ischemic strokes from a comprehensive stroke center","volume":"11","author":"Absher","year":"2024","journal-title":"Sci Data"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1250","DOI":"10.1001\/jamaneurol.2024.3659","article-title":"Mobile stroke unit management in patients with acute ischemic stroke eligible for intravenous thrombolysis","volume":"81","author":"Mac Grory","year":"2024","journal-title":"JAMA Neurol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1246","DOI":"10.3174\/ajnr.A8307","article-title":"Risk of hemorrhagic transformation after mechanical thrombectomy without versus with IV thrombolysis for acute ischemic stroke: a systematic review and meta-analysis of randomized clinical trials","volume":"45","author":"Jazayeri","year":"2024","journal-title":"Am J Neuroradiol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"107641","DOI":"10.1016\/j.jstrokecerebrovasdis.2024.107641","article-title":"Intravenous thrombolysis for ischemic stroke in the posterior circulation: a systematic review and meta-analysis","volume":"33","author":"Knapen","year":"2024","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e040304","DOI":"10.1161\/JAHA.124.040304","article-title":"Comparing early National Institutes of Health stroke scale versus 90-day modified Rankin scale outcomes in acute ischemic stroke trials: a systematic review and analysis","volume":"14","author":"Rinkel","year":"2025","journal-title":"J Am Heart Assoc"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1085","DOI":"10.4103\/jfmpc.jfmpc_1431_23","article-title":"Modified Rankin scale is a reliable tool for the rapid assessment of stroke severity and predicting disability outcomes","volume":"13","author":"Nimbvikar","year":"2024","journal-title":"J Family Med Prim Care"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1136\/svn-2024-003977","article-title":"Chinese stroke association guidelines on reperfusion therapy for acute ischaemic stroke 2024","volume":"10","author":"Xiong","year":"2025","journal-title":"Stroke Vasc Neurol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1001\/jama.2025.12063","article-title":"Alteplase for acute ischemic stroke at 4.5 to 24 hours: the HOPE randomized clinical trial","volume":"334","author":"Zhou","year":"2025","journal-title":"JAMA"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1016\/S0140-6736(24)02809-5","article-title":"Normobaric hyperoxia combined with endovascular treatment for acute ischaemic stroke in China (OPENS-2 trial): a multicentre, randomised, single-blind, sham-controlled trial","volume":"405","author":"Li","year":"2025","journal-title":"Lancet"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"15","DOI":"10.4103\/aian.aian_842_23","article-title":"The pitfalls of NIHSS: time for a new clinical acute stroke severity scoring system in the emergency?","volume":"27","author":"Makharia","year":"2024","journal-title":"Ann Indian Acad Neurol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"31","DOI":"10.47353\/jsocmed.v3i2.128","article-title":"The use of NIHSS as an assessment of acute stroke severity","volume":"3","author":"Imran","year":"2024","journal-title":"J Soc Med"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e213863","DOI":"10.1212\/WNL.0000000000213863","article-title":"Meta-analysis of randomized controlled trials on IV thrombolysis in patients with minor acute ischemic stroke","volume":"105","author":"Doheim","year":"2025","journal-title":"Neurology"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"5270","DOI":"10.1212\/WNL.0000000000205695","article-title":"Comparison of NIHSS within 7-day and 90-day mRS outcomes in randomized-controlled trials of acute ischemic stroke: a systematic review and meta-analysis (P1-5.024)","volume":"102","author":"Rinkel","year":"2024","journal-title":"Neurology"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e344","DOI":"10.1161\/STR.0000000000000211","article-title":"Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association\/American Stroke Association","volume":"50","author":"Powers","year":"2019","journal-title":"Stroke"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1016\/S0140-6736(19)30038-8","article-title":"Intensive blood pressure reduction with intravenous thrombolysis therapy for acute ischaemic stroke (ENCHANTED): an international, randomised, open-label, blinded-endpoint, phase 3 trial","volume":"393","author":"Anderson","year":"2019","journal-title":"Lancet"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1159\/000334186","article-title":"Blood pressure variability after intravenous thrombolysis in acute stroke does not predict intracerebral hemorrhage but poor outcome","volume":"33","author":"Kellert","year":"2012","journal-title":"Cerebrovasc Dis"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"e032813","DOI":"10.1161\/JAHA.123.032813","article-title":"Ischemic stroke in patients with congenital heart disease and atrial fibrillation","volume":"13","author":"Holmgren","year":"2024","journal-title":"J Am Heart Assoc"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"7845","DOI":"10.18632\/aging.205786","article-title":"Left ventricular systolic dysfunction predicts clinical prognosis in patients with acute ischemic stroke after intravenous thrombolysis","volume":"16","author":"Zhang","year":"2024","journal-title":"Aging (Albany NY)"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"e13247","DOI":"10.1111\/psyg.13247","article-title":"Development and validation of a nomogram for delirium in the old ischaemic stroke patients","volume":"25","author":"Cai","year":"2025","journal-title":"Psychogeriatrics"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"2957","DOI":"10.1161\/01.STR.0000249054.96644.c6","article-title":"The stroke-thrombolytic predictive instrument: a predictive instrument for intravenous thrombolysis in acute ischemic stroke","volume":"37","author":"Kent","year":"2006","journal-title":"Stroke"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1177\/1747493018765490","article-title":"The START nomogram for individualized prediction of the probability of unfavorable outcome after intravenous thrombolysis for stroke","volume":"13","author":"Cappellari","year":"2018","journal-title":"Int J Stroke"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1754895\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T09:10:17Z","timestamp":1771924217000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1754895\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,23]]},"references-count":27,"alternative-id":["10.3389\/fneur.2026.1754895"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1754895","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,23]]},"article-number":"1754895"}}