Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy; Department of Brain Sciences, Imperial College London, UK.
J Neurol Sci. 2024 Nov 15;466:123211. doi: 10.1016/j.jns.2024.123211. Epub 2024 Sep 2.
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.
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.
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.
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.
在双联抗血小板治疗（DAPT）成为标准治疗后，小动脉闭塞（SAO）引起的小卒中（MIS）的结局尚未得到充分描述。我们提供了接受早期短期 DAPT 治疗的 SAO-MIS 的短期预后的最新数据，并比较了 SAO-MIS 与非-SAO-MIS 患者的结局。
这是一项前瞻性多中心真实世界研究（READAPT，NCT05476081）的预设亚分析，纳入了接受 DAPT 治疗的（NIHSS≤5）非心源性缺血性小卒中患者。主要结局是 90 天症状性缺血性卒中或主要心血管事件的复合结局。次要结局是 90 天改良 Rankin 量表（mRS）评分的序贯分布、90 天良好的功能结局（mRS 0-1）和 24 小时早期神经功能恶化（END）。安全性结局为 90 天内颅内出血、中重度和任何出血。所有结局均在 SAO-MIS 和非-SAO-MIS 患者之间进行比较。
我们纳入了 678 例 MIS，其中 253 例（37.3%）与 SAO 相关。90 天时，3 例 SAO-MIS 患者发生主要结局（1.2%[95%CI 0.2%-3.5%]），均为 SAO 相关的缺血性卒中。对于次要结局，大多数 SAO-MIS 患者（n=191，75.5%）90 天内功能结局良好，12 例发生 24 小时 END（4.7%[95%CI 2.5%-8.3%]）。关于安全性结局，90 天内颅内出血仅发生在 1 例 SAO-MIS 患者（0.4%[95%CI 0.0%-2.2%]）。与非-SAO-MIS 相比，SAO-MIS 患者 90 天内复发性血管事件的风险显著降低（aHR 0.24[95%CI 0.08-0.68]；p=0.007），而其他次要结局以及安全性事件的风险无显著差异。
我们的研究结果表明，接受 DAPT 治疗的 SAO-MIS 患者总体预后良好。未来的研究应探讨与残余卒中风险相关的因素和 SAO-MIS 的长期结局。
