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Clopidogrel plus Aspirin for Symptomatic Intracranial Atherosclerotic Stenosis: A Pilot Study

Tareq Kass-Hout1, Melanie Winningham2, Omar Kass-Hout3

  • 1Department of Neurology, Emory University School of Medicine, Atlanta, Ga, USA; Department of Neurosciences, Rochester Regional Health, Rochester, N.Y, USA.

Interventional Neurology
|October 27, 2016
PubMed

Insights

Prolonged dual antiplatelet therapy for symptomatic intracranial atherosclerotic disease showed 0% vascular events at 1 year. This approach for secondary stroke prevention may reduce risks without increasing bleeding complications.

Area of Science:

  • Neurology
  • Cardiology
  • Vascular Medicine

Background:

  • Limited data exist on optimal dual antiplatelet therapy (DAPT) duration for secondary stroke prevention.
  • Symptomatic intracranial atherosclerotic disease poses a significant risk for recurrent cerebrovascular events.

Purpose of the Study:

  • To evaluate the efficacy and safety of a prolonged DAPT course (12 months) in patients with symptomatic intracranial atherosclerotic disease.
  • To compare outcomes with the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial.

Main Methods:

  • Retrospective analysis of 25 patients with high-grade (70-99%) symptomatic intracranial stenosis treated with aspirin plus clopidogrel for 12 months.
  • Aggressive medical management following the SAMMPRIS protocol, including gastrointestinal prophylaxis.
  • Comparison of clinical and safety outcomes with the medical arm of the SAMMPRIS trial.

Main Results:

  • No stroke, myocardial infarction, or vascular death occurred in the cohort at 1 year (0% vs. 16% in SAMMPRIS, p=0.03).
  • Major bleeding rates were similar between the study cohort and the SAMMPRIS cohort (4% vs. 2.2%, p=1.0).
  • Achievement of blood pressure and LDL cholesterol targets was comparable between cohorts.

Conclusions:

  • A prolonged duration of dual antiplatelet therapy may be associated with reduced vascular events in symptomatic intracranial atherosclerotic disease.
  • This extended DAPT strategy appears safe, with no significant increase in major bleeding complications.
  • Further research is warranted to confirm these findings and establish optimal DAPT duration.
Abstract

Keywords:
Acute ischemic strokeDual antiplatelet therapyIntracranial atherosclerotic diseaseTransient ischemic attack

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