1) Investigate the effects of thrombolysis and/or thrombectomy versus standard-of-care on non-mRS patient-centered outcomes (e.g. quality of life, cognition, pain, fatigue, mood) in minor-moderate acute ischemic stroke (NIHSS <9); 2) Determine which non-mRS patient-centered outcomes have been used as secondary measures in acute stroke trials including minor-moderate strokes.

Reperfusion therapy is standard-of-care treatment for eligible individuals with acute moderate-severe ischemic strokes. The best approach to treatment for minor strokes is an area of uncertainty. Whether to treat minor stroke with reperfusion therapy, associated with rare but serious adverse events, generally depends on the perception of the physician and patient as to whether the deficit could be “disabling.” The mRS is used to assess functional outcomes in clinical trials but may be insensitive to “invisible” sequelae (e.g. mood, cognition, pain, fatigue) that contribute to quality of life and may not be appreciated in the acute setting.

We performed a systematic review of randomized trials studying thrombolysis and/or thrombectomy for acute ischemic stroke including participants with NIHSS <9. Databases searched include Medline, Embase, PsycINFO, Cochrane, and clinicaltrials.gov (January 1995 - July 2019). Extracted data includes study characteristics, demographics, stroke severity, intervention(s), mRS and available non-mRS outcome measures. The study protocol is submitted to PROSPERO.

We anticipate that patient-centered outcomes are not frequently measured in acute stroke trials, even in those including minor-moderate strokes. We hope that our results will be hypothesis-generating and will draw attention to the need to collect these outcomes for future trials in populations with lower baseline stroke severity.