To investigate the understanding of minor ischemic stroke (MIS) among clinicians involved in acute ischemic stroke (AIS) care in Beijing and to identify the key factors influencing their decision-making regarding intravenous thrombolysis (IVT) for these patients.

An online questionnaire survey was conducted among clinicians participating in AIS treatment in Beijing from April to June 2023 by SoJump. Statistical analysis was performed using SPSS 20.0 software, focusing on: 1) knowledge of MIS prevalence, definition, and classification; 2) guideline recommendations for IVT in MIS; 3) factors influencing IVT decision-making.

A total of 303 valid questionnaires were collected from 80 hospitals, with a valid questionnaire rate of 100%. The proportions of clinicians who believed that MIS accounted for less than 30%, 30%-<40% and 40%- <50% in AIS were 15.84%, 38.61% and 17.49%, respectively. Concerning guideline recommendation, 87.13% of clinicians approved of "thrombolytic therapy for mild disability patients", while only 48.51% of clinicians approved of "no thrombolysis for mild non-disabling patients". Among the factors considered by clinicians in supporting MIS IVT, from the patient's perspective, the top three in descending orders were "symptom disability" (95.38%), "gradual/rapid progression of symptoms "(94.06%) and "impact on daily work and life" (90.76%); From the perspective of clinicians themselves, the top three in descending orders were "possibility of worsening or progression of the condition" (97.03%), "disability of patient symptoms" (93.73%), and "low risk of MIS thrombolysis bleeding" (72.94%). Among the factors considered by clinicians who did not support MIS IVT, from the patient's perspective, they were "comorbidity with high-risk bleeding diseases" (90.10%), "patient and family members not actively/difficult to communicate" (86.14%), and "comorbidity with multiple other diseases" (81.52%). From the perspective of clinicians themselves, the following were: "patients had relative contraindications" (67.99%), "some patients were non-disabled" (56.44%), and "concerns about bleeding risk" (41.91%). The proportion of clinicians who believed that the risk of (syndrome intracerebral hemorrhage) sICH during MIS intravenous thrombolysis was <1.0%, 1.0%-<2.0%, 2.0%-<3.0%, 3.0%-<4.0% and 4.0%-<5.0% were 43.56%, 20.46%, 14.85%, 9.57%, 2.64%, and 8.91%, respectively.

"Symptom disability" was the primary factor motivating IVT use for MIS. Knowledge gaps exist among clinicians regarding MIS epidemiology, prognosis, and thrombolysis risks, with a tendency to overestimate sICH risk. Enhanced evidence-based guidance, academic training, and updated diagnostic and therapeutic concepts are needed to ensure appropriate MIS patients receive timely, scientific treatment.