Abstract TP131: Factors Influencing the Prognosis of Symptomatic and Asymptomatic Intracranial Atherosclerosis after Antiplatelet treatment: Substudy of Trials of Cilostazol in Symptomatic Intracranial Stenosis -2

Abstract

Background: Intracranial atherosclerosis (ICAS) is a major cause of stroke, and the degree of stenosis changes dynamically during medical treatment. However, factors associated with the prognosis of ICAS are not verified clearly. Therefore, we have investigated the factors which are related to the prognosis of symptomatic and asymptomatic ICAS. Methods: This study is performed as a substudy of Trials of cilostazol in symptomatic intracranial stenosis (TOSS)-2. From 20 centers, 409 patients with acute symptomatic ICAS were participated. The prognosis of ICAS was categorized to regression, progression and no change according to the change of MR angiogram between base-line and 7 months of antiplatelet treatment. Factors including clinical, laboratory data and the severity of stenosis were compared among the patients grouped by the prognosis of symptomatic or asymptomatic ICAS. Results: After treatment, symptomatic ICAS regressed in 110 patients and progressed in 52 patients, and asymptomatic ICAS regressed in 38 patients and progressed in 19 patients. Higher initial severity of symptomatic ICAS and high density lipoprotein (HDL) cholesterol were independently related with lesser progression of symptomatic ICAS (p<0.001 and p=0.013; respectively). And for asymptomatic ICAS, higher initial severity of asymptomatic ICAS, use of angiotensin receptor blocker (ARB) and lower initial fasting glucose level were related with lesser progression (p<0.001, p=0.010 and p=0.008; respectively). Conclusion: The higher initial degree of stenosis was related with a better radiologic outcome of ICAS after medical treatment. Therefore, though the initial severity is high, ICAS may regress by appropriate treatment with antiplatelet agents.