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Intracranial and systemic atherosclerosis in the NAVIGATE ESUS trial: Recurrent stroke risk and response to antithrombotic therapy
dc.creator | Ameriso S.F., Amarenco P., Pearce L.A., Perera K.S., Ntaios G., Lang W., Bereczki D., Uchiyama S., Kasner S.E., Yoon B.-W., Lavados P., Firstenfeld A., Mikulik R., Povedano G.P., Ferrari J., Mundl H., Berkowitz S.D., Connolly S.J., Hart R.G. | en |
dc.date.accessioned | 2023-01-31T07:31:06Z | |
dc.date.available | 2023-01-31T07:31:06Z | |
dc.date.issued | 2020 | |
dc.identifier | 10.1016/j.jstrokecerebrovasdis.2020.104936 | |
dc.identifier.issn | 10523057 | |
dc.identifier.uri | http://hdl.handle.net/11615/70474 | |
dc.description.abstract | Background: Non-stenotic intracranial and systemic atherosclerosis are associated with ischemic stroke. We report frequency and response to anticoagulant vs. antiplatelet prophylaxis of patients with embolic stroke of undetermined source (ESUS) who have non-stenotic intracranial atherosclerosis and/or systemic atherosclerosis. Methods: Exploratory analysis of the international NAVIGATE ESUS randomized trial comparing rivaroxaban 15mg daily with aspirin 100mg daily in 7213 patients with recent ESUS. Among participants with results of intracranial arterial imaging with either computed tomographic angiography (CTA) or magnetic resonance angiography (MRA), the frequency and predictors of non-stenotic intracranial and systemic atherosclerosis and responses to antithrombotic therapy were assessed. Results: Among 4723 participants with available intracranial CTA or MRA results (65% of the trial cohort), the prevalence of intracranial atherosclerosis was 16% (n=739). Patient features independently associated with intracranial atherosclerosis included East Asian region (odds ratio 2.7, 95%CI 2.2,3.3) and cervical carotid plaque (odds ratio 2.3, 95%CI 1.9,2.7), among others. The rate of recurrent ischemic stroke averaged 4.8%/year among those with intracranial atherosclerosis vs. 5.0.%/year for those without (HR 0.95, 95%CI 0.65, 1.4). Among those with intracranial atherosclerosis, the recurrent ischemic stroke rate was higher if assigned to rivaroxaban (5.8%/year) vs. aspirin (3.7%/year), but the difference was not statistically significant (HR 1.6, 95%CI 0.78, 3.3). There was trend for the effect of antithrombotic treatments to be different according to the presence or absence of intracranial atherosclerosis (pinteraction=0.09). Among participants with evidence of systemic atherosclerosis by either history or imaging (n=3820), recurrent ischemic stroke rates were similar among those assigned to rivaroxaban (5.5%/year) vs. aspirin (4.9%/year)(HR 1.1, 95%CI 0.84, 1.5). Conclusions: East Asia region was the strongest factor associated with intracranial atherosclerosis. There were no statistically significant differences between rivaroxaban and aspirin prophylaxis for recurrent ischemic stroke in patients with non-stenotic intracranial atherosclerosis and/or systemic atherosclerosis. © 2020 | en |
dc.language.iso | en | en |
dc.source | Journal of Stroke and Cerebrovascular Diseases | en |
dc.source.uri | https://www.scopus.com/inward/record.uri?eid=2-s2.0-85086039881&doi=10.1016%2fj.jstrokecerebrovasdis.2020.104936&partnerID=40&md5=277519da3bdd1e7ae629f6437eafeb0d | |
dc.subject | acetylsalicylic acid | en |
dc.subject | anticoagulant agent | en |
dc.subject | antithrombocytic agent | en |
dc.subject | hydroxymethylglutaryl coenzyme A reductase inhibitor | en |
dc.subject | rivaroxaban | en |
dc.subject | acetylsalicylic acid | en |
dc.subject | antithrombocytic agent | en |
dc.subject | blood clotting factor 10a inhibitor | en |
dc.subject | fibrinolytic agent | en |
dc.subject | rivaroxaban | en |
dc.subject | adult | en |
dc.subject | aged | en |
dc.subject | Article | en |
dc.subject | atherosclerosis | en |
dc.subject | atherosclerotic plaque | en |
dc.subject | atrial fibrillation | en |
dc.subject | brain atherosclerosis | en |
dc.subject | brain blood vessel | en |
dc.subject | brain embolism | en |
dc.subject | brain ischemia | en |
dc.subject | carotid artery | en |
dc.subject | cerebrovascular accident | en |
dc.subject | cohort analysis | en |
dc.subject | computed tomographic angiography | en |
dc.subject | double blind procedure | en |
dc.subject | East Asian | en |
dc.subject | exploratory research | en |
dc.subject | female | en |
dc.subject | hazard ratio | en |
dc.subject | human | en |
dc.subject | hyperlipidemia | en |
dc.subject | magnetic resonance angiography | en |
dc.subject | major clinical study | en |
dc.subject | male | en |
dc.subject | middle aged | en |
dc.subject | multicenter study | en |
dc.subject | National Institutes of Health Stroke Scale | en |
dc.subject | phase 3 clinical trial | en |
dc.subject | prevalence | en |
dc.subject | priority journal | en |
dc.subject | recurrence risk | en |
dc.subject | recurrent disease | en |
dc.subject | transcranial Doppler ultrasonography | en |
dc.subject | transient ischemic attack | en |
dc.subject | treatment response | en |
dc.subject | brain atherosclerosis | en |
dc.subject | brain embolism | en |
dc.subject | cerebrovascular accident | en |
dc.subject | clinical trial | en |
dc.subject | comparative study | en |
dc.subject | controlled study | en |
dc.subject | diagnostic imaging | en |
dc.subject | peripheral occlusive artery disease | en |
dc.subject | randomized controlled trial | en |
dc.subject | risk assessment | en |
dc.subject | risk factor | en |
dc.subject | time factor | en |
dc.subject | treatment outcome | en |
dc.subject | Aged | en |
dc.subject | Aspirin | en |
dc.subject | Double-Blind Method | en |
dc.subject | Factor Xa Inhibitors | en |
dc.subject | Female | en |
dc.subject | Fibrinolytic Agents | en |
dc.subject | Humans | en |
dc.subject | Intracranial Arteriosclerosis | en |
dc.subject | Intracranial Embolism | en |
dc.subject | Male | en |
dc.subject | Middle Aged | en |
dc.subject | Peripheral Arterial Disease | en |
dc.subject | Platelet Aggregation Inhibitors | en |
dc.subject | Prevalence | en |
dc.subject | Recurrence | en |
dc.subject | Risk Assessment | en |
dc.subject | Risk Factors | en |
dc.subject | Rivaroxaban | en |
dc.subject | Stroke | en |
dc.subject | Time Factors | en |
dc.subject | Treatment Outcome | en |
dc.subject | W.B. Saunders | en |
dc.title | Intracranial and systemic atherosclerosis in the NAVIGATE ESUS trial: Recurrent stroke risk and response to antithrombotic therapy | en |
dc.type | journalArticle | en |
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