Prevalence and Effect of Cerebral Small Vessel Disease in Stroke Patients With Aspirin Treatment Failure-A Hospital-Based Stroke Secondary Prevention Registry.

Ping-Song Chou,Chi-Hung Liu,Han-Hwa Hu,Chun-Pai Yang,Shey-Lin Wu,Helen L Po,A-Ching Chao,Tsang-Shan Chen,Chi-Hsun Lien,Ray-Chang Tzeng,Yi-Te Tsai,Shang-Chang Ho,Pi-Shan Sung,Yueh-Feng Sung

doi:10.3389/fneur.2021.645444

Abstract

Background: Breakthrough strokes during treatment with aspirin, termed clinical aspirin treatment failure (ATF), is common in clinical practice. The burden of cerebral small vessel disease (SVD) is associated with an increased recurrent ischemic stroke risk. However, the association between SVD and ATF remains unclear. This study investigated the prevalence and clinical characteristics of SVD in stroke patients with ATF.Methods: Data from a prospective, and multicenter stroke with ATF registry established in 2018 in Taiwan were used, and 300 patients who developed ischemic stroke concurrent with regular use of aspirin were enrolled. White matter lesions (WMLs) and cerebral microbleeds (CMBs) were identified using the Fazekas scale and Microbleed Anatomical Rating Scale, respectively. Demographic data, cardiovascular comorbidities, and index stroke characteristics of patients with different WML and CMB severities were compared. Logistic regression analyses were performed to explore the factors independently associated with outcomes after ATF.Results: The mean patient age was 69.5 ± 11.8 years, and 70.0% of patients were men. Among all patients, periventricular WML (PVWML), deep WML (DWML), and CMB prevalence was 93.3, 90.0, and 52.5%, respectively. Furthermore, 46.0% of the index strokes were small vessel occlusions. Severe PVWMLs and DWMLs were significantly associated with high CMB burdens. Patients with moderate-to-severe PVWMLs and DWMLs were significantly older and had higher cardiovascular comorbidity prevalence than did patients with no or mild WMLs. Moreover, patients with favorable outcomes exhibited significantly low prevalence of severe PVWMLs (p = 0.001) and DWMLs (p = 0.001). After logistic regression was applied, severe WMLs predicted less favorable outcomes independently, compared with those with no to moderate PVWMLs and DWMLs [odds ratio (OR), 0.47; 95% confidence interval (CI), 0.25–0.87 for severe PVWMLs; OR, 0.40; 95% CI, 0.21–0.79 for severe DWMLs].Conclusions: SVD is common in stroke patients with ATF. PVWMLs and DWMLs are independently associated with functional outcomes in stroke patients with ATF. The burden of SVD should be considered in future antiplatelet strategies for stroke patients after ATF.

Highlights

Stroke is the second leading cause of death worldwide and results in disability in a large proportion of survivors [1]
The total burden of small vessel disease (SVD) was reported to be positively associated with the risk of recurrent ischemic strokes and intracerebral hemorrhage (ICH) in patients with a prior transient ischemic attack (TIA) or ischemic stroke [4]
The Essen Stroke Risk Score (ESRS), a 10-point scale derived from Clopidogrel vs. Aspirin in Patients at Risk of Ischemic Events (CAPRIE) trial [16], was applied to predict the risk of recurrent ischemic stroke after the index stroke, based on the cardiovascular comorbidities [17, 18]

Summary

Introduction

Stroke is the second leading cause of death worldwide and results in disability in a large proportion of survivors [1]. Aspirin is the most commonly used antiplatelet agent for the secondary prevention of ischemic stroke because of its low cost and availability [6]. Aspirin was determined to reduce the risk of ischemic stroke by 22% in secondary prevention [7]. Patients who develop an ischemic stroke during aspirin treatment, termed clinical aspirin treatment failure (ATF), represent 30–40% and 40–50% of patients with stroke in clinical trials [8,9,10], and in clinical practice [11,12,13], respectively. Breakthrough strokes during treatment with aspirin, termed clinical aspirin treatment failure (ATF), is common in clinical practice. The burden of cerebral small vessel disease (SVD) is associated with an increased recurrent ischemic stroke risk. This study investigated the prevalence and clinical characteristics of SVD in stroke patients with ATF

Methods

Results

Conclusion