Evaluation of intracranial atherosclerotic stenosis burden, the use of dual antiplatelet therapy, and stroke recurrence in patients with minor stroke.

Abstract

Background: Intracranial atherosclerotic stenosis (ICAS) is a primary cause of ischemic stroke, but it might not be the main predictor of stroke recurrence.

Objectives: A comprehensive assessment of dual antiplatelet therapy (DAPT) effectiveness via ICAS burden (ICASB) is crucial for patients with minor stroke.

Methods: This prospective, multicenter cohort study included patients with minor (National Institutes of Health Stroke Scale score ≤5) stroke. The ICASB was determined by the degree and number of ICAS occurrences. The primary efficacy outcomes were all stroke types (ischemic or hemorrhagic). Ninety-day and 1-year follow-up evaluations were conducted.

Results: Among 3061 patients (age = 61.7 ± 12.0 years; males, 73.3%), 61.0% (n = 1868) received DAPT, and 39.0% (n = 1193) received single APT. Finally, 2900 and 2709 patients were included in the 90-day and 1-year outcome assessments, respectively. The primary outcome occurred in 242 patients (8.3%) at 90 days and 353 patients (13.0%) at the 1-year follow-up. In patients with high ICASB (but not those with low ICASB), compared with single APT, DAPT was associated with a lower recurrent stroke rate at the 90-day (weighted absolute risk difference, 7.3%; inverse probability of treatment weighted hazard ratio, 0.58; 95% CI, 0.39-0.87) and 1-year (weighted absolute risk difference, 3.9%; inverse probability of treatment weighted hazard ratio, 0.68; 95% CI, 0.45-1.03) follow-ups. Significant interactions were observed at the 90-day (P_interaction = .021) and 1-year (P_interaction = .086) follow-ups. Similar results were observed for the propensity score matched model.

Conclusion: For minor stroke patients receiving APT, DAPT reduced stroke recurrence at 90 days in the high ICASB group but not in the low ICASB group.

Trial registration: Unique identifier: ChiCTR1900025214.