Intracranial and systemic atherosclerosis in the NAVIGATE ESUS trial: Recurrent stroke risk and response to antithrombotic therapy

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dc.contributor.authorAmeriso, Sebastian F.
dc.contributor.authorAmarenco, Pierre
dc.contributor.authorPearce, Lesly A
dc.contributor.authorPerera, Kanjana S
dc.contributor.authorNtaios, George
dc.contributor.authorLang, Wilfried
dc.contributor.authorBereczki, Daniel
dc.contributor.authorUchiyama, Shinichiro
dc.contributor.authorKasner, Scott E
dc.contributor.authorYoon, Byung-Woo
dc.contributor.authorLavados, Pablo
dc.contributor.authorFirstenfeld, Alfredo
dc.contributor.authorMikulik, Robert
dc.contributor.authorPovedano, Guillermo Pablo
dc.contributor.authorFerrari, Jorge
dc.contributor.authorMundl, Hardi
dc.contributor.authorBerkowitz, Scott D.
dc.contributor.authorConnolly, Stuart J.
dc.contributor.authorHart, Robert G
dc.date.accessioned2021-10-25T16:05:40Z
dc.date.available2021-10-25T16:05:40Z
dc.date.issued2020
dc.description.abstractNon-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 patienes
dc.identifier.citationJournal of Stroke and Cerebrovascular Diseases, Vol. 29, No. 8 (August), 2020: 1049361es
dc.identifier.urihttps://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104936es
dc.identifier.urihttp://hdl.handle.net/11447/4903
dc.subjectEmbolic strokees
dc.subjectESUSes
dc.subjectRivaroxabanes
dc.subjectCerebrovascular atherosclerosises
dc.subjectIntracranial atherosclerosises
dc.subjectRandomized triales
dc.titleIntracranial and systemic atherosclerosis in the NAVIGATE ESUS trial: Recurrent stroke risk and response to antithrombotic therapyes
dc.typeArticlees

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