Multiterritory Brain Infarcts, Anticoagulation, and Recurrence After Cryptogenic Stroke: A Subgroup Analysis of the...

Area of Science:

• Neurology
• Cardiology
• Stroke Medicine

Background:

• Cryptogenic stroke characteristics, recurrence risk, and anticoagulation response remain unclear.
• The ARCADIA trial investigated atrial cardiopathy in cryptogenic stroke patients.
• Baseline infarcts were assessed across anterior, posterior, and left anterior circulation.

Purpose of the Study:

• To determine if atrial cardiopathy biomarkers or LVEF are associated with multiterritory brain infarcts.
• To examine the association between the number of infarct territories and recurrent stroke risk.
• To investigate if infarct territory number modifies the effect of apixaban versus aspirin on recurrent stroke.

Main Methods:

• Screened patients for atrial cardiopathy using ECG and NT-proBNP levels.
• Assessed infarct territories using baseline MRI data.
• Employed ANCOVA and Cox regression for statistical analysis.

Main Results:

• Atrial cardiopathy biomarkers and LVEF were not associated with the number of infarct territories.
• Infarcts in 2 or 3 territories significantly increased recurrent stroke risk compared to single-territory infarction.
• The number of infarct territories did not alter the comparative effectiveness of apixaban versus aspirin.

Conclusions:

• Multiterritory brain infarction in cryptogenic stroke is not linked to atrial cardiopathy biomarkers or LVEF.
• Multiterritory infarction independently elevates recurrent stroke risk.
• Apixaban did not offer a greater reduction in recurrent stroke risk compared to aspirin in this context.