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.
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Foschi Matteo, De Matteis Eleonora, De Santis Federico, Romoli Michele, Tassinari Tiziana, Saia Valentina, Cenciarelli Silvia, Bedetti Chiara, Padiglioni Chiara, Censori Bruno, Puglisi Valentina, Vinciguerra Luisa, Guarino Maria, Barone Valentina, Zedde Marialuisa, Grisendi Ilaria, Diomedi Marina, Bagnato Maria Rosaria, Petruzzellis Marco, Mezzapesa Domenico Maria, Di Viesti Pietro, Inchingolo Vincenzo, Cappellari Manuel, Zivelonghi Cecilia, Candelaresi Paolo, Andreone Vincenzo, Rinaldi Giuseppe, Bavaro Alessandra, Cavallini Anna, Moraru Stefan, Querzani Pietro, Terruso Valeria, Mannino Marina, Pezzini Alessandro, Frisullo Giovanni, Muscia Francesco, Paciaroni Maurizio, Mosconi Maria Giulia, Zini Andrea, Leone Ruggiero, Palmieri Carmela, Cupini Letizia Maria, Marcon Michela, Tassi Rossana, Sanzaro Enzo, Paci Cristina, Viticchi Giovanna, Orsucci Daniele, Falcou Anne, Diamanti Susanna, Tarletti Roberto, Nencini Patrizia, Rota Eugenia, Sepe Federica Nicoletta, Ferrandi Delfina, Caputi Luigi, Volpi Gino, La Spada Salvatore, Beccia Mario, Rinaldi Claudia, Mastrangelo Vincenzo, Di Blasio Francesco, Invernizzi Paolo, Pelliccioni Giuseppe, De Angelis Maria Vittoria, Bonanni Laura, Ruzza Giampietro, Caggia Emanuele Alessandro, Russo Monia, Tonon Agnese, Acciarri Maria Cristina, Anticoli Sabrina, Roberti Cinzia, Manobianca Giovanni, Scaglione Gaspare, Pistoia Francesca, Fortini Alberto, De Boni Antonella, Sanna Alessandra, Chiti Alberto, Barbarini Leonardo, Caggiula Marcella, Masato Maela, Del Sette Massimo, Passarelli Francesco, Bongioanni Maria Roberta, Toni Danilo, Ricci Stefano, Sacco Simona, Ornello Raffaele
Аннотация
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.