Dual antiplatelet therapy in stroke and ICAS

Liping Liu(Chinese University of Hong Kong), Ka Sing Wong(Chinese University of Hong Kong), Xinyi Leng(Chinese University of Hong Kong), Yuehua Pu(Chinese University of Hong Kong), Yilong Wang(Chinese University of Hong Kong), Jing Jing(Chinese University of Hong Kong), Xinying Zou(Chinese University of Hong Kong), Yuesong Pan(Chinese University of Hong Kong), Anxin Wang(Chinese University of Hong Kong), Xia Meng(Chinese University of Hong Kong), Chunxue Wang(Chinese University of Hong Kong), Xingquan Zhao(Chinese University of Hong Kong), Yannie Soo(Chinese University of Hong Kong), S. Claiborne Johnston(Chinese University of Hong Kong), Yongjun Wang(Chinese University of Hong Kong), For the CHANCE Investigators(Chinese University of Hong Kong), Zhimin Wang(Chinese University of Hong Kong), Yongjun Wang(Chinese University of Hong Kong), Haiqin Xia(Chinese University of Hong Kong), Bin Li, Guiru Zhang(Chinese University of Hong Kong), Xudong Ren(Chinese University of Hong Kong), Chunling Ji, Guohua Zhang(Chinese University of Hong Kong), Jianhua Li, Bohua Lu(Chinese University of Hong Kong), Liping Wang, Shutao Feng(Chinese University of Hong Kong), Dali Wang, Weiguo Tang(Chinese University of Hong Kong), Juntao Li, Hongtian Zhang(Chinese University of Hong Kong), Guanglai Li(Chinese University of Hong Kong), Baojun Wang, Yuhua Chen(Chinese University of Hong Kong), Ying Lian(Chinese University of Hong Kong), Bin Liu, Junfang Teng, Rubo Sui(Chinese University of Hong Kong), Lejun Li, Zhiling Yuan, Dawei Zang, Zuneng Lu(Chinese University of Hong Kong), Li Sun(Chinese University of Hong Kong), Dong Wang, Liying Hou, Dongcai Yuan, Yongliang Cao(Chinese University of Hong Kong), Hui Li, Xiuge Tan(Chinese University of Hong Kong), Huicong Wang, Haisong Du(Chinese University of Hong Kong), Mingyi Liu(Chinese University of Hong Kong), Suping Wang(Chinese University of Hong Kong), Qiuwu Liu, Zhong Zhang, Qifu Cui(Chinese University of Hong Kong), Runqing Wang(Chinese University of Hong Kong), Jialin Zhao, Jiewen Zhang(Chinese University of Hong Kong), Jianping Zhao, Qi Bi, Xiyou Qi(Chinese University of Hong Kong), Junyan Liu(Chinese University of Hong Kong), Changxin Li(Chinese University of Hong Kong), Ling Lv Li(Chinese University of Hong Kong), Xiaoping Pan, Junling Zhang, Derang Jiao(Chinese University of Hong Kong), Zhao Han, Dawei Qian(Chinese University of Hong Kong), Jin Xiao(Chinese University of Hong Kong), Yan Xing, Huishan Du, Guang Huang, Yongqiang Cui(Chinese University of Hong Kong), Yan Li, Lianyuan Feng, Lianbo Gao(Chinese University of Hong Kong), Bo Xiao, Yibin Cao, Yiping Wu(Chinese University of Hong Kong), Jinfeng Liu, Zhiming Zhang, Zhengxie Dong(Chinese University of Hong Kong), Limin Wang(Chinese University of Hong Kong), Li He(Chinese University of Hong Kong), Xinchen Wang, Xueying Guo(Chinese University of Hong Kong), Ming Wang(Chinese University of Hong Kong), Xiaosha Wang, Jian‐Dong Jiang(Chinese University of Hong Kong), Renliang Zhao, Shengnian Zhou(Chinese University of Hong Kong), Hao Hu, Maolin He(Chinese University of Hong Kong), Fengchun Yu, Quping Ouyang, Jingbo Zhang(Chinese University of Hong Kong), Anding Xu, Xiaokun Qi(Chinese University of Hong Kong), Lei Wang, Fuming Shi, Fuqiang Guo(Chinese University of Hong Kong), Jianfeng Wang(Chinese University of Hong Kong), Fengli Zhao, Ronghua Dou, Dongning Wei(Chinese University of Hong Kong), Qingwei Meng(Chinese University of Hong Kong), Yilu Xia(Chinese University of Hong Kong), Shimin Wang(Chinese University of Hong Kong), Zhangcang Xue(Chinese University of Hong Kong), Yuming Xu(Chinese University of Hong Kong), Liping Ma(Chinese University of Hong Kong), Chun Wang(Tang Hospital), Jiang Wu, Yifeng Du(Chinese University of Hong Kong), Yinzhou Wang(Tang Hospital), Lijun Xiao(Chinese University of Hong Kong), Fucong Song(Chinese University of Hong Kong), Wenli Hu, Zhigang Chen(Chinese University of Hong Kong), Qingrui Liu, Jiemin Zhang, Mei Chen, Xiaodong Yuan(Chinese University of Hong Kong), Zhihui Liu(Chinese University of Hong Kong), Guozhong Li(Chinese University of Hong Kong), Xiaohong Li, Tingchen Tian
Neurology
August 29, 2015
10.1212/wnl.0000000000001972
Cited by 198Open Access
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Abstract

UNLABELLED: AB OBJECTIVE: We aimed to investigate whether the efficacy and safety of clopidogrel plus aspirin vs aspirin alone were consistent between patients with and without intracranial arterial stenosis (ICAS), in the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial. METHODS: We assessed the interaction of the treatment effects of the 2 antiplatelet therapies among patients with and without ICAS, identified by magnetic resonance angiography (MRA) in CHANCE (ClinicalTrials.gov identifier NCT00979589). RESULTS: Overall, 1,089 patients with MRA images available in CHANCE were included in this subanalysis, 608 patients (55.8%) with ICAS and 481 (44.2%) without. Patients with ICAS had higher rates of recurrent stroke (12.5% vs 5.4%; p<0.0001) at 90 days than those without. But there was no statistically significant treatment by presence of ICAS interaction on either the primary outcome of any stroke (hazard ratio for clopidogrel plus aspirin vs aspirin alone: 0.79 [0.47-1.32] vs 1.12 [0.56-2.25]; interaction p=0.522) or the safety outcome of any bleeding event (interaction p=0.277). CONCLUSIONS: The results indicated higher rate of recurrent stroke in minor stroke or high-risk TIA patients with ICAS than in those without. However, there was no significant difference in the response to the 2 antiplatelet therapies between patients with and without ICAS in the CHANCE trial. Classification of evidence: This study provides Class II evidence that for patients with acute minor stroke or TIA with and without ICAS identified by MRA, clopidogrel plus aspirin is not significantly different than aspirin alone in preventing recurrent stroke.

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