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

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dc.contributor.author Ameriso, Sebastián Francisco
dc.contributor.author Amarenco, Pierre
dc.contributor.author Pearce, Lesly A.
dc.contributor.author Perera, Kanjana S.
dc.contributor.author Ntaios, George
dc.contributor.author Lang, Wilfried
dc.contributor.author Bereczki, Daniel
dc.contributor.author Uchiyama, Shinichiro
dc.contributor.author Kasner, Scott E.
dc.contributor.author Yoon, Byung-Woo
dc.contributor.author Lavados, Pablo M.
dc.contributor.author Firstenfeld, Alfredo
dc.contributor.author Mikulik, Robert
dc.contributor.author Povedano, Guillermo Pablo
dc.contributor.author Ferrari, Jorge
dc.contributor.author Mundl, Hardi
dc.contributor.author Berkowitz, Scott D.
dc.contributor.author Connolly, Stuart J.
dc.contributor.author Hart, Robert G.
dc.date.accessioned 2021-03-03T12:04:08Z
dc.date.available 2021-03-03T12:04:08Z
dc.date.issued 2020-08
dc.identifier.citation Ameriso, S F., Amarenco, P., Pearce, L.A., Perera, K.S., Ntaios, G., Lang, W., Bereczki, D., Uchiyama, S., Kasner, S.E., Yoon, B.W., Lavados, P., Firstenfeld, A., Mikulik, R., Povedano, G.P., Ferrari, J., Mundl, H., Berkowitz, S.D., Connolly, S.J., Hart, R.G., 2020. Intracranial and systemic atherosclerosis in the NAVIGATE ESUS trial: Recurrent stroke risk and response to antithrombotic therapy. J Stroke Cerebrovasc Dis 29, 104936. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104936 en_US
dc.identifier.uri http://localhost:8080/xmlui/handle/123456789/372
dc.identifier.uri https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104936
dc.description.abstract Background: Non-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 patients with non-stenotic intracranial atherosclerosis and/or systemic atherosclerosis. en_US
dc.language.iso eng en_US
dc.publisher Elsevier en_US
dc.rights info:eu-repo/semantics/openAccess
dc.rights.uri https://creativecommons.org/licenses/by/2.5/ar/
dc.subject Intracranial Arteriosclerosis en_US
dc.subject Arteriosclerosis Intracraneal en_US
dc.subject Risk Factors en_US
dc.subject Factores de Riesgo en_US
dc.title Intracranial and systemic atherosclerosis in the NAVIGATE ESUS trial: Recurrent stroke risk and response to antithrombotic therapy en_US
dc.type info:eu-repo/semantics/publishedVersion
dc.type info:eu-repo/semantics/article en_US
dc.description.fil Fil: Ameriso, Sebastián Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Vascular; Argentina.
dc.description.fil Fil: Mundl, Hardi. Bayer; Alemania.
dc.description.fil Fil: Hart, Robert G. Population Health Research Institute; Canadá.
dc.description.fil Fil: Amarenco, Pierre. Bichat Hospital. Department of Neurology; Francia.
dc.description.fil Fil: Pearce, Lesly A. Biostatistics Consultant; Estados Unidos.
dc.description.fil Fil: Perera, Kanjana S. McMaster University/Population Health Research Institute. Department of Medicine (Neurology); Canadá.
dc.description.fil Fil: Ntaios, George. University of Thessaly. Department of Medicine; Grecia.
dc.description.fil Fil: Lang, Wilfried. Sigmund Freud Private University. Hospital St. John of God. Medical Faculty; Austria.
dc.description.fil Fil: Bereczki, Daniel. Semmelweis University. Department of Neurology; Hungría.
dc.description.fil Fil: Uchiyama, Shinichiro. Sanno Hospital and Sanno Medical Center. International University of Health and Welfare; Japón.
dc.description.fil Fil: Kasner, Scott E. University of Pennsylvania. Department of Neurology; Estados Unidos.
dc.description.fil Fil: Yoon, Byung Woo. Seoul National University Hospital. Department of Neurology; Corea.
dc.description.fil Fil: Lavados, Pablo M. Universidad del Desarrollo. Clinica Alemana de Santiago; Chile .
dc.description.fil Fil: Firstenfeld, Alfredo. Instituto Cardiologico Banfield; Argentina.
dc.description.fil Fil: Mikulik, Robert. St. Anne's University Hospital and Masaryk University. International Clinical Research Center and Neurology Department; República Checa.
dc.description.fil Fil: Povedano, Guillermo Pablo. Complejo Medico de la PFA Churruca Visca; Argentina.
dc.description.fil Fil: Ferrari, Jorge. Hospital Interzonal General de Agudos Eva Peron; Argentina.
dc.description.fil Fil: Berkowitz, Scott D. Bayer. Pharmaceuticals Clinical Development Thrombosis; Estados Unidos.
dc.description.fil Fil: Connolly, Stuart J. McMaster University / Population Health Research Institute. Department of Medicine (Cardiology); Canadá.
dc.relation.ispartofVOLUME 29
dc.relation.ispartofNUMBER 8
dc.relation.ispartofPAGINATION 104936
dc.relation.ispartofCOUNTRY Estados Unidos
dc.relation.ispartofCITY Nueva York
dc.relation.ispartofTITLE Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.
dc.relation.ispartofISSN 1532-8511
dc.type.snrd info:ar-repo/semantics/artículo es_ES


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