Defining short-term outcomes of minor ischemic stroke due to small artery occlusion in the era of dual antiplatelet treatment: A READAPT study sub-analysis.

Autor: Foschi M; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy., De Matteis E; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy; Department of Brain Sciences, Imperial College London, UK., De Santis F; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy., Romoli M; Stroke Unit, Maurizio Bufalini Hospital, Cesena, Italy., Tassinari T; Department of Neurology, Santa Corona Hospital, Pietra Ligure, Italy., Saia V; Department of Neurology, Santa Corona Hospital, Pietra Ligure, Italy., Cenciarelli S; Department of Neurology, Città di Castello Hospital, Città di Castello, Italy., Bedetti C; Department of Neurology, Città di Castello Hospital, Città di Castello, Italy., Padiglioni C; Department of Neurology, Città di Castello Hospital, Città di Castello, Italy., Censori B; Department of Neurology, ASST Cremona Hospital, Cremona, Italy., Puglisi V; Department of Neurology, ASST Cremona Hospital, Cremona, Italy., Vinciguerra L; Department of Neurology, ASST Cremona Hospital, Cremona, Italy., Guarino M; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy., Barone V; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy., Zedde M; Department of Neurology, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy., Grisendi I; Department of Neurology, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy., Diomedi M; Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy., Bagnato MR; Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy., Petruzzellis M; Stroke Unit, 'F. Puca' AOU Consorziale Policlinico, Bari, Italy., Mezzapesa DM; Stroke Unit, 'F. Puca' AOU Consorziale Policlinico, Bari, Italy., Di Viesti P; Department of Neurology, Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy., Inchingolo V; Department of Neurology, Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy., Cappellari M; Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy., Zivelonghi C; Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy., Candelaresi P; Stroke Unit, AORN Antonio Cardarelli, Naples, Italy., Andreone V; Stroke Unit, AORN Antonio Cardarelli, Naples, Italy., Rinaldi G; Department of Neurology, Di Venere Hospital, Bari, Italy., Bavaro A; Department of Neurology, Di Venere Hospital, Bari, Italy., Cavallini A; Neurologia d'Urgenza-Stroke Unit, IRCCS Mondino Foundation, Pavia, Italy., Moraru S; Neurologia d'Urgenza-Stroke Unit, IRCCS Mondino Foundation, Pavia, Italy., Querzani P; Neurology Unit, S.Maria delle Croci Hospital, Ravenna, Italy., Terruso V; Department of Neurology, AOOR Villa Sofia-Cervello, Palermo, Italy., Mannino M; Department of Neurology, AOOR Villa Sofia-Cervello, Palermo, Italy., Pezzini A; Department of Medicine and Surgery, University of Parma, Parma, Italy; Stroke Care Program, Department of Emergencies, Parma Universiry Hospital, Parma, Italy., Frisullo G; Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy., Muscia F; Department of Neurology, ASST-Ovest Milanese, Legnano, Italy., Paciaroni M; Department of Internal and Cardiovascular Medicine, Santa Maria della Misericordia Hospital, Perugia, Italy., Mosconi MG; Department of Internal and Cardiovascular Medicine, Santa Maria della Misericordia Hospital, Perugia, Italy., Zini A; IRCCS Istituto delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy., Leone R; Stroke Unit, 'M. R. Dimiccoli' Hospital, Barletta, ASL BT, Italy., Palmieri C; Medical Department, E. Agnelli Hospital - Local Health Company (ASL) TO3, Pinerolo, Italy., Cupini LM; Stroke Unit, S. Eugenio Hospital, Rome, Italy., Marcon M; Department of Neurology, Cazzavillan Hospital, Arzignano, Italy., Tassi R; Emergency Department, Azienda Ospedaliera Universitaria Senese, Siena, Italy., Sanzaro E; Department of Neurology, Umberto I Hospital, Siracusa, Italy., Paci C; Neurology Unit, Ospedale 'Madonna del Soccorso', San Benedetto del Tronto, Italy., Viticchi G; Experimental and Clinical Medicine Department, Marche Polytechnic University, Ancona, Italy., Orsucci D; Neurology Unit, San Luca Hospital, Lucca and Castelnuovo Garfagnana, Italy., Falcou A; Stroke Unit, Policlinico Umberto I Hospital, Rome, Italy., Diamanti S; Department of Neurology, Fondazione IRCCS San Gerardo dei Tintori Monza, Italy., Tarletti R; Stroke Unit, Azienda Ospedaliero-Universitaria 'Maggiore della Carità', Novara, Italy., Nencini P; Stroke Unit, Careggi University Hospital, Florence, Italy., Rota E; Department of Neurology, San Giacomo Hospital, Novi Ligure, Italy., Sepe FN; Stroke Unit, SS. Biagio e Arrigo, Alessandria, Italy., Ferrandi D; Stroke Unit, SS. Biagio e Arrigo, Alessandria, Italy., Caputi L; Department of Cardiocerebrovascular Diseases, ASST Ospedale Maggiore di Crema, Crema, Italy., Volpi G; Department of Neurology, San Jacopo Hospital, Pistoia, Italy., La Spada S; Department of Neurology, Antonio Perrino Hospital, Brindisi, Italy., Beccia M; Department of Neurology, Sant'Andrea Hospital, Rome, Italy., Rinaldi C; Neurology Unit, 'Infermi' Hospital, Rimini, Italy., Mastrangelo V; Neurology Unit, 'Infermi' Hospital, Rimini, Italy., Di Blasio F; Stroke Unit, 'S.Spirito' Hospital, Pescara, Italy., Invernizzi P; Departiment of Neurology, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy., Pelliccioni G; Department of Neurology INRCA, Ancona, Italy., De Angelis MV; Stroke Unit, 'S.Spirito' Hospital, Pescara, Italy; Department of Neurology, SS Annunziata Hospital, Chieti, Italy., Bonanni L; Dipartimento di Medicina e Scienze dell'Invecchiamento, Università G. d'Annunzio di Chieti-Pescara, Italy., Ruzza G; Department of Neurology, Civil Hospital, Cittadella, Italy., Caggia EA; Cardio-Neuro-Vascular Department, Neurology Unit, Giovanni Paolo II Hospital, Ragusa, Italy., Russo M; Department of Neurology, St Misericordia Hospital, Rovigo, Italy., Tonon A; Department of Neurology, Ospedale Civile Ss. Giovanni e Paolo, Venezia, Italy., Acciarri MC; Department of Neurology, A. Murri Fermo Hospital, Fermo, Italy., Anticoli S; Stroke Unit, Azienda Ospedaliera San Camillo, Rome, Italy., Roberti C; Department of Neurology, San Filippo Neri Hospital, Rome, Italy., Manobianca G; Department of Neurology, General Regional Hospital 'F. Miulli', Acquaviva delle Fonti, Italy., Scaglione G; Department of Neurology, General Regional Hospital 'F. Miulli', Acquaviva delle Fonti, Italy., Pistoia F; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy., Fortini A; Internal Medicine, San Giovanni di Dio Hospital, Florence, Italy., De Boni A; Department of Neuroscience, San Bortolo Hospital, Vicenza, Italy., Sanna A; Stroke Unit, AOU Sassari, Italy., Chiti A; Neurology Unit, Apuane Hospital, Massa Carrara, Italy., Barbarini L; Department of Neurology, Vito Fazi Hospital, Lecce, Italy., Caggiula M; Department of Neurology, Vito Fazi Hospital, Lecce, Italy., Masato M; Department of Neurology, Mirano Hospital, Italy., Del Sette M; Neuroscience, IRCCS Ospedale Policlinico San Martino, Genoa, Italy., Passarelli F; Department of Neurology, Fatebenefratelli Hospital, Rome, Italy., Bongioanni MR; Department of Neurology, SS Annunziata Hospital, Savigliano, Italy., Toni D; Department of Human neurosciences, La Sapienza University, Rome, Italy., Ricci S; Department of Neurology, Città di Castello Hospital, Città di Castello, Italy; Coordinatore Comitato Scientifico ISA-AII, Città di Castello, Italy., Sacco S; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy. Electronic address: simona.sacco@univaq.it., Ornello R; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Jazyk: angličtina
Zdroj: Journal of the neurological sciences [J Neurol Sci] 2024 Nov 15; Vol. 466, pp. 123211. Date of Electronic Publication: 2024 Sep 02.
DOI: 10.1016/j.jns.2024.123211
Abstrakt: Background: The outcomes of minor ischemic stroke resulting from small artery occlusion (SAO-MIS) have not yet been characterized after dual antiplatelet treatment (DAPT) has become the standard of care. We provided updated figures on the short-term prognosis of SAO-MIS treated with early short-term DAPT and compared the outcomes of SAO-MIS versus non-SAO-MIS patients.
Methods: This is a prespecified sub-analysis from a prospective multicentric real-world study (READAPT, NCT05476081) including patients with minor (NIHSS≤5) non-cardioembolic ischemic stroke treated with DAPT. The primary outcome was a composite of 90-day symptomatic ischemic stroke or major cardiovascular events. Secondary outcomes were the 90-day ordinal distribution of modified Rankin Scale (mRS) scores, 90-day excellent functional outcome (mRS of 0 to 1), and 24-h early neurological deterioration (END). Safety outcomes were 90-day intracerebral hemorrhage, moderate-to-severe and any bleedings. All outcomes were compared between SAO-MIS and non-SAO-MIS patients.
Results: We included 678 MIS, of whom 253 (37.3 %) were SAO-related. At 90 days, 3 patients with SAO-MIS had primary outcome (1.2 % [95 % CI 0.2 %-3.5 %]), which were all SAO-related ischemic strokes. For the secondary outcomes, most SAO-MIS patients (n = 191, 75.5 %) had 90-day excellent functional outcome and 12 had 24-h END (4.7 % [95 % CI 2.5 %-8.3 %]). Referring to safety outcomes, 90-day intracerebral hemorrhage occurred only in one patient with SAO-MIS (0.4 % [95 % CI 0.0 %- 2.2 %]). Compared to non-SAO-MIS, the 90-day risk of recurrent vascular events was significantly lower among SAO-MIS (aHR 0.24 [95 % CI 0.08-0.68]; p = 0.007), while there were not significant differences in other secondary outcomes, nor in the risk of safety events.
Conclusions: Our findings show overall favorable short-term prognosis after SAO-MIS treated with DAPT. Future studies should investigate factors associated with residual stroke risk and long-term outcomes of SAO-MIS.
Competing Interests: Declaration of competing interest Andrea Zini reports compensation from Angels Initiative, Boehringer-Ingelheim, Daiichi Sankyo for consultant services; from Angels Initiative, Boehringer-Ingelheim, CSL Behring for speaking honoraria or other education services; from Daiichi Sankyo for meeting; from Bayer, and Astra Zeneca for participation on a Data Safety, Monitoring Board or Advisory Board; and he is member of ESO guidelines, ISA-AII guidelines, and IRETAS steering committee. Raffaele Ornello reports grants from Novartis and Allergan; compensation from Teva Pharmaceutical Industries, Eli Lilly and Company, and Novartis for other services; and travel support from Teva Pharmaceutical Industries. Simona Sacco reports compensation from Novartis, NovoNordisk, Allergan, AstraZeneca, Pfizer Canada, Inc., Eli Lilly and Company, Teva Pharmaceutical Industries, H. Lundbeck A/S, and Abbott Canada for consultant services; employment by University of L'Aquila; and compensation from Novartis for other services. Maurizio Paciaroni reports compensation from Daiichi Sankyo Company, Bristol Myers Squibb, Bayer, and Pfizer Canada, Inc., for consultant services. Danilo Toni reports compensation from Alexion, Astra Zeneca, Medtronic, and Pfizer for consultant services and participation on a Data Safety, Monitoring Board or Advisory Board. The other authors report no conflicts.
(Copyright © 2024 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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