High-sensitive C-reactive protein and dual antiplatelet in intracranial arterial stenosis

Area of Science:

• Neurology
• Cardiology
• Biomarkers

Background:

• Intracranial arterial stenosis (ICAS) is a significant risk factor for recurrent stroke.
• High-sensitive C-reactive protein (hsCRP) is an inflammatory biomarker associated with cardiovascular events.
• The efficacy of dual antiplatelet therapy (DAPT) in patients with ICAS and varying hsCRP levels requires further elucidation.

Purpose of the Study:

• To investigate the relationship between hsCRP levels and the effectiveness of DAPT in patients with and without ICAS.
• To identify patient subgroups who may benefit most from DAPT for secondary stroke prevention.

Main Methods:

• Analysis of a subgroup of 807 patients from the CHANCE trial with available magnetic resonance angiography and hsCRP measurements.
• Utilized Cox proportional hazards models to assess interactions between hsCRP levels and antiplatelet therapy effects.
• Compared outcomes between DAPT (clopidogrel plus aspirin) and single antiplatelet therapy (aspirin alone).

Main Results:

• Patients with ICAS had a higher proportion of elevated hsCRP levels compared to those without (40.2% vs 30.1%).
• A significant interaction was observed between hsCRP levels and DAPT efficacy in patients with ICAS (p=0.012).
• DAPT significantly reduced recurrent stroke risk compared to aspirin alone, specifically in ICAS patients with nonelevated hsCRP levels (aHR 0.27; p=0.006).

Conclusions:

• The combination of ICAS and nonelevated hsCRP levels may predict a superior response to DAPT.
• This finding suggests a potential role for hsCRP in tailoring antiplatelet therapy for minor stroke or high-risk TIA patients.
• Further large-scale randomized trials are warranted to validate these results.