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Multicenter Study
. 2024 Nov 15:466:123211.
doi: 10.1016/j.jns.2024.123211. Epub 2024 Sep 2.

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

Matteo Foschi  1 , Eleonora De Matteis  2 , Federico De Santis  1 , Michele Romoli  3 , Tiziana Tassinari  4 , Valentina Saia  4 , Silvia Cenciarelli  5 , Chiara Bedetti  5 , Chiara Padiglioni  5 , Bruno Censori  6 , Valentina Puglisi  6 , Luisa Vinciguerra  6 , Maria Guarino  7 , Valentina Barone  7 , Marialuisa Zedde  8 , Ilaria Grisendi  8 , Marina Diomedi  9 , Maria Rosaria Bagnato  9 , Marco Petruzzellis  10 , Domenico Maria Mezzapesa  10 , Pietro Di Viesti  11 , Vincenzo Inchingolo  11 , Manuel Cappellari  12 , Cecilia Zivelonghi  12 , Paolo Candelaresi  13 , Vincenzo Andreone  13 , Giuseppe Rinaldi  14 , Alessandra Bavaro  14 , Anna Cavallini  15 , Stefan Moraru  15 , Pietro Querzani  16 , Valeria Terruso  17 , Marina Mannino  17 , Alessandro Pezzini  18 , Giovanni Frisullo  19 , Francesco Muscia  20 , Maurizio Paciaroni  21 , Maria Giulia Mosconi  21 , Andrea Zini  22 , Ruggiero Leone  23 , Carmela Palmieri  24 , Letizia Maria Cupini  25 , Michela Marcon  26 , Rossana Tassi  27 , Enzo Sanzaro  28 , Cristina Paci  29 , Giovanna Viticchi  30 , Daniele Orsucci  31 , Anne Falcou  32 , Susanna Diamanti  33 , Roberto Tarletti  34 , Patrizia Nencini  35 , Eugenia Rota  36 , Federica Nicoletta Sepe  37 , Delfina Ferrandi  37 , Luigi Caputi  38 , Gino Volpi  39 , Salvatore La Spada  40 , Mario Beccia  41 , Claudia Rinaldi  42 , Vincenzo Mastrangelo  42 , Francesco Di Blasio  43 , Paolo Invernizzi  44 , Giuseppe Pelliccioni  45 , Maria Vittoria De Angelis  46 , Laura Bonanni  47 , Giampietro Ruzza  48 , Emanuele Alessandro Caggia  49 , Monia Russo  50 , Agnese Tonon  51 , Maria Cristina Acciarri  52 , Sabrina Anticoli  53 , Cinzia Roberti  54 , Giovanni Manobianca  55 , Gaspare Scaglione  55 , Francesca Pistoia  1 , Alberto Fortini  56 , Antonella De Boni  57 , Alessandra Sanna  58 , Alberto Chiti  59 , Leonardo Barbarini  60 , Marcella Caggiula  60 , Maela Masato  61 , Massimo Del Sette  62 , Francesco Passarelli  63 , Maria Roberta Bongioanni  64 , Danilo Toni  65 , Stefano Ricci  66 , Simona Sacco  67 , Raffaele Ornello  1
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Free article
Multicenter Study

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

Matteo Foschi et al. J Neurol Sci. .
Free article

Abstract

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.

Keywords: Dual antiplatelet treatment; Etiology; Ischemic stroke; Outcomes; Small artery occlusion.

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Conflict of interest statement

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.

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