Stroke recurrence rates differ by MRI infarction patterns

By Reuters Staff

NEW YORK (Reuters Health) - In patients with transient ischemic attack (TIA) and minor stroke, stroke-recurrence rates differ according to MRI infarction patterns.

A recent registry study showed that patients with multiple acute infarctions (MAIs) have a higher risk of stroke recurrence than do those with single acute infarction (SAI) or no acute infarction (NAI).

Dr. Yilong Wang from Capital Medical University, in Beijing, China, and colleagues used data from the CHANCE trial to examine whether infarction patterns can be used to stratify the risk of recurrent stroke within three months of a TIA or minor ischemic stroke. They also evaluated the efficacy and safety of clopidogrel plus aspirin versus aspirin alone in patients with different infarction patterns.

In the main CHANCE trial, clopidogrel plus aspirin was superior to aspirin alone in reducing the risk of recurrent stroke, without increasing hemorrhagic risk.

In the current study, the rate of recurrent stroke at three months was significantly higher in patients with MAI (14.2%) than in patients with SAI (8.7%) or NAI (2.0%), the researchers report in JAMA Neurology, online March 26. MAI and SAI were independently associated with recurrence, compared with NAI.

Results were similar at 12-month follow-up.

Among patients with MAI, stroke recurrence rates were significantly lower among those treated with clopidogrel plus aspirin than among those treated with aspirin alone (10.1% vs. 18.8%, P=0.04).

In contrast, among patients with SAI or NAI, stroke recurrence rates did not differ significantly between clopidogrel plus aspirin and aspirin alone.

The risk of moderate to severe bleeding was not increased in the clopidogrel plus aspirin group compared to the aspirin alone group, regardless of MRI infarction pattern.

“Infarction patterns can efficiently stratify the risk of recurrent stroke within 3 months of noncardioembolic TIA or minor ischemic stroke,” the researchers conclude. “These findings indicated that MAIs may be a target for more intensive antithrombotic therapy in future studies.”

The analysis had no commercial funding.

Dr. Wang did not respond to a request for comments.


JAMA Neurol 2018.

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