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Early intensive therapy for preventing neurological deterioration in branch atheromatous disease
Yen-Chu Huang1, Hsu-Huei Weng2, Yuan-Hsiung Tsai2
1Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, No. 6 West Chia-Pu Road, Putz City, Chiayi County 613, Taiwan.
Insights
Early intensive therapy, including dual antiplatelet therapy (DAPT) and high-intensity statins, significantly reduces early neurological deterioration (END) in patients with branch atheromatous disease (BAD). This approach improves recovery without increasing safety risks.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Clinical Trials
Background:
- Branch atheromatous disease (BAD) is a stroke subtype linked to early neurological deterioration (END) and poor patient outcomes.
- Optimal treatment strategies for BAD remain undefined, despite similarities to large artery atherosclerosis.
Purpose of the Study:
- To evaluate the efficacy and safety of early dual antiplatelet therapy (DAPT) combined with high-intensity statins.
- To determine if this intensive treatment reduces END and improves outcomes in patients with BAD.
Main Methods:
- A prospective, single-arm study with historical controls (NCT04824911).
- Patients received aspirin, clopidogrel, and high-intensity statins within 24 hours of symptom onset.
- Outcomes compared to a historical cohort receiving standard antiplatelet therapy and lower-intensity statins.
Main Results:
- The primary endpoint (END or recurrent stroke) was less frequent with intensive therapy (34.1% vs. 48.1%).
- Intensive therapy significantly reduced END within 7 days and improved functional outcomes at 90 days.
- No significant differences were observed in recurrent stroke rates, major bleeding, or mortality between groups.
Conclusions:
- Early intensive therapy with DAPT and high-intensity statins is effective in reducing END and improving recovery in BAD.
- This treatment approach appears safe, with no increase in major bleeding or mortality.
- Further research is recommended to validate these findings in larger, prospective studies.
Background:
Branch atheromatous disease (BAD) is a subtype of ischemic stroke associated with early neurological deterioration (END) and poor outcomes. Although BAD shares features with large artery atherosclerosis, optimal treatment strategies remain undefined.
Objectives:
To assess the efficacy and safety of early dual antiplatelet therapy (DAPT) and high-intensity statins in reducing END and improving outcomes in BAD.
Design:
A prospective, single-arm study with a historical control group.
Methods:
This study reports the results of the Statin and Dual Antiplatelet Therapy in Preventing Early Neurological Deterioration in Branch Atheromatous Disease trial. Patients with BAD-related ischemic stroke were treated with aspirin, clopidogrel, and high-intensity statins within 24 h of symptom onset. Outcomes were compared with a historical control cohort treated with single antiplatelet therapy and moderate- or low-intensity statins. The primary outcome was the composite of END (defined as an National Institutes of Health Stroke Scale score increase ⩾2 points within 7 days) or recurrent stroke within 30 days. Secondary outcomes included severe END, functional outcomes at 90 days, and safety events.
Results:
A total of 91 patients received intensive therapy and 285 received standard treatment. The primary endpoint occurred less frequently in the intensive group (34.1% vs 48.1%; adjusted risk ratio (aRR), 0.71; 95% confidence interval (CI), 0.52-0.98; p = 0.034). Intensive therapy significantly reduced END at 7 days (34.1% vs 47.0%; aRR, 0.73; 95% CI, 0.54-1.00; p = 0.049) but not recurrent stroke at 30 days (2.2% vs 1.8%; aRR, 1.16; 95% CI, 0.25-5.43). Good outcomes at 90 days (modified Rankin Scale ⩽2) were more common with intensive therapy (73.6% vs 57.2%; aRR, 1.27; 95% CI, 1.09-1.48; p = 0.002). Major bleeding and mortality did not differ between groups.
Conclusion:
Early intensive therapy with DAPT and high-intensity statins significantly reduced END and improved recovery in BAD without compromising safety. Further studies are warranted to validate these findings.
Trial Registration:
ClinicalTrials.gov; Identifier: NCT04824911 (https://clinicaltrials.gov/study/NCT04824911).
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