Key result
Recurrent ischemic stroke due to extracranial atherosclerosis was independently associated with a higher likelihood of high-on-aspirin platelet reactivity compared to intracranial atherosclerosis (OR 5.760).
Why the study?
Ischemic stroke recurs despite antiplatelet agents, and high-on-aspirin platelet reactivity may differ between recurrent stroke caused by intracranial atherosclerosis and extracranial atherosclerosis.
Does high-on-aspirin platelet reactivity differ between recurrent ischemic stroke due to extracranial versus intracranial atherosclerosis in patients on aspirin?
Observational (n=190)
No
Does high-on-aspirin platelet reactivity differ between recurrent ischemic stroke due to extracranial versus intracranial atherosclerosis in patients on aspirin?
Odds Ratio: 5.76 (95% CI 2.154–15.403)
Absolute Event Rate: 27.8% vs 12.6%
p-value: p=<0.001
Recurrent ischemic stroke due to extracranial atherosclerosis is more strongly associated with high-on-aspirin platelet reactivity and artery-to-artery embolism compared to intracranial atherosclerosis.
BACKGROUND AND PURPOSE: Ischemic stroke recurs despite the use of antiplatelet agents. Various mechanisms are involved in recurrence due to intracranial atherosclerosis (ICAS) and extracranial atherosclerosis (ECAS). High-on-aspirin platelet reactivity (HAPR) may differ between recurrent stroke due to ICAS and ECAS. METHODS: Patients with recurrent ischemic stroke as a result of large-artery atherosclerosis despite taking aspirin were enrolled consecutively. Ischemic stroke was classified as stroke due to ICAS or ECAS according to the location of the culprit stenosis. An aspirin reaction units (ARU) value of >550 IU was defined as HAPR. HAPR and its associated factors were compared between the two groups and also considering the mechanism of stroke. RESULTS: <0.001) was independently associated with HAPR. The ARU value differed according to the stroke mechanism, and was highest in those with artery-to-artery embolism. Artery-to-artery embolism was independently associated with HAPR in both the ICAS and ECAS groups. CONCLUSIONS: Recurrent stroke due to ECAS was more strongly associated with HAPR and insufficient antiplatelet inhibition than was that due to ICAS. Artery-to-artery embolism was associated with HAPR in recurrent ischemic stroke as a result of ICAS or ECAS.
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Noh et al. (2022) conducted an observational in Recurrent ischemic stroke with large-artery atherosclerosis (n=190). Extracranial atherosclerosis (ECAS) vs. Intracranial atherosclerosis (ICAS) was evaluated on High-on-aspirin platelet reactivity (HAPR) (OR 5.760, 95% CI 2.154-15.403, p=<0.001). Recurrent ischemic stroke due to extracranial atherosclerosis was independently associated with a higher likelihood of high-on-aspirin platelet reactivity compared to intracranial atherosclerosis (OR 5.760).
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