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

J 2020

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

AMERISO, S. F., P. AMARENCO, L. A. PEARCE, K. S. PERERA, G. NTAIOS et. al.

Basic information

Original name

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

Authors

AMERISO, S. F. (32 Argentina, guarantor), P. AMARENCO (250 France), L. A. PEARCE (840 United States of America), K. S. PERERA (124 Canada), G. NTAIOS (300 Greece), W. LANG (40 Austria), D. BERECZKI (348 Hungary), S. UCHIYAMA (392 Japan), S. E. KASNER (840 United States of America), B. W. YOON (410 Republic of Korea), P. LAVADOS (152 Chile), A. FIRSTENFELD (32 Argentina), Robert MIKULÍK (203 Czech Republic, belonging to the institution), G. P. POVEDANO (32 Argentina), J. FERRARI (32 Argentina), H. MUNDL (276 Germany), S. D. BERKOWITZ (484 Mexico), S. J. CONNOLLY (124 Canada) and R. G. HART (124 Canada)

Edition

JOURNAL OF STROKE & CEREBROVASCULAR DISEASES, AMSTERDAM, ELSEVIER SCIENCE BV, 2020, 1052-3057

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30103 Neurosciences

Country of publisher

Netherlands

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 2.136

RIV identification code

RIV/00216224:14110/20:00116376

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104936

UT WoS

000561808800040

Keywords in English

Embolic stroke; ESUS-Rivaroxaban; Cerebrovascular atherosclerosis; Intracranial atherosclerosis; Randomized trial

Abstract

V originále

Background: Non-stenotic intracranial and systemic atherosclerosis are associated with ischemic stroke. We report frequency and response to anticoagulant vs. anti-platelet 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 angi-ography (MRA), the frequency and predictors of non-stenotic intracranial and sys-temic 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 pla-que (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 intracra-nial 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. aspi-rin (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 statisti-cally significant differences between rivaroxaban and aspirin prophylaxis for recur-rent ischemic stroke in patients with non-stenotic intracranial atherosclerosis and/ or systemic atherosclerosis.

Citovat

AMERISO, S. F., P. AMARENCO, L. A. PEARCE, K. S. PERERA, G. NTAIOS, W. LANG, D. BERECZKI, S. UCHIYAMA, S. E. KASNER, B. W. YOON, P. LAVADOS, A. FIRSTENFELD, Robert MIKULÍK, G. P. POVEDANO, J. FERRARI, H. MUNDL, S. D. BERKOWITZ, S. J. CONNOLLY and R. G. HART. Intracranial and systemic atherosclerosis in the NAVIGATE ESUS trial: Recurrent stroke risk and response to antithrombotic therapy. JOURNAL OF STROKE & CEREBROVASCULAR DISEASES. AMSTERDAM: ELSEVIER SCIENCE BV, 2020, vol. 29, No 8, p. 1-8. ISSN 1052-3057. Available from: https://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104936.

@article{1677982,
   author = {Ameriso, S. F. and Amarenco, P. and Pearce, L. A. and Perera, K. S. and Ntaios, G. and Lang, W. and Bereczki, D. and Uchiyama, S. and Kasner, S. E. and Yoon, B. W. and Lavados, P. and Firstenfeld, A. and Mikulík, Robert and Povedano, G. P. and Ferrari, J. and Mundl, H. and Berkowitz, S. D. and Connolly, S. J. and Hart, R. G.},
   article_location = {AMSTERDAM},
   article_number = {8},
   doi = {http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104936},
   keywords = {Embolic stroke; ESUS-Rivaroxaban; Cerebrovascular atherosclerosis; Intracranial atherosclerosis; Randomized trial},
   language = {eng},
   issn = {1052-3057},
   journal = {JOURNAL OF STROKE & CEREBROVASCULAR DISEASES},
   title = {Intracranial and systemic atherosclerosis in the NAVIGATE ESUS trial: Recurrent stroke risk and response to antithrombotic therapy},
   url = {https://www.sciencedirect.com/science/article/pii/S1052305720303426?via%3Dihub},
   volume = {29},
   year = {2020}
}

TY  - JOUR
ID  - 1677982
AU  - 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. - Mikulík, Robert - Povedano, G. P. - Ferrari, J. - Mundl, H. - Berkowitz, S. D. - Connolly, S. J. - Hart, R. G.
PY  - 2020
TI  - Intracranial and systemic atherosclerosis in the NAVIGATE ESUS trial: Recurrent stroke risk and response to antithrombotic therapy
JF  - JOURNAL OF STROKE & CEREBROVASCULAR DISEASES
VL  - 29
IS  - 8
SP  - 1-8
EP  - 1-8
PB  - ELSEVIER SCIENCE BV
SN  - 10523057
KW  - Embolic stroke
KW  - ESUS-Rivaroxaban
KW  - Cerebrovascular atherosclerosis
KW  - Intracranial atherosclerosis
KW  - Randomized trial
UR  - https://www.sciencedirect.com/science/article/pii/S1052305720303426?via%3Dihub
L2  - https://www.sciencedirect.com/science/article/pii/S1052305720303426?via%3Dihub
N2  - Background: Non-stenotic intracranial and systemic atherosclerosis are associated with ischemic stroke. We report frequency and response to anticoagulant vs. anti-platelet 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 angi-ography (MRA), the frequency and predictors of non-stenotic intracranial and sys-temic 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 pla-que (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 intracra-nial 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. aspi-rin (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 statisti-cally significant differences between rivaroxaban and aspirin prophylaxis for recur-rent ischemic stroke in patients with non-stenotic intracranial atherosclerosis and/ or systemic atherosclerosis.
ER  -

AMERISO, S. F., P. AMARENCO, L. A. PEARCE, K. S. PERERA, G. NTAIOS, W. LANG, D. BERECZKI, S. UCHIYAMA, S. E. KASNER, B. W. YOON, P. LAVADOS, A. FIRSTENFELD, Robert MIKULÍK, G. P. POVEDANO, J. FERRARI, H. MUNDL, S. D. BERKOWITZ, S. J. CONNOLLY and R. G. HART. Intracranial and systemic atherosclerosis in the NAVIGATE ESUS trial: Recurrent stroke risk and response to antithrombotic therapy. \textit{JOURNAL OF STROKE \&{}amp; CEREBROVASCULAR DISEASES}. AMSTERDAM: ELSEVIER SCIENCE BV, 2020, vol.~29, No~8, p.~1-8. ISSN~1052-3057. Available from: https://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104936.

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