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*See page 1493 for full list of participants.
From the Department of Neurology (Drs. Chimowitz and Strong), University of Michigan Medical Center, Ann Arbor, MI; Department of Neurology (Drs. Kokkinos and Levine), Henry Ford Hospital and Health Science Center (Detroit campus of Case Western Reserve University), Detroit, MI; Department of Biostatistics (Dr. Brown), University of Michigan, Ann Arbor, MI; Department of Neurology (Drs. Silliman and Pessin), Tufts-New England Medical Center, Boston, MA; Department of Neurology (Drs. Sila and Furlan, and E. Weichel), Cleveland Clinic Foundation, Cleveland, OH; Department of Neurology (Drs. Kargman and Sacco), Columbia-Presbyterian Medical Center, New York, NY; Department of Neurology (Dr. Wityk), Sinai Hospital of Baltimore, MD; and Department of Neurology (Drs. Ford and Fayad), Yale University School of Medicine, New Haven, CT.
Supported in part by NIH grant NS23393 and the American Heart Association, Michigan Affiliate (grant-in-aid; Dr. Levine), and NIH grant NS27517 (Dr. Sacco).
Received September 16, 1994. Accepted in final form January 4, 1995.
Address correspondence and reprint requests to Dr. Marc I. Chimowitz, Department of Neurology, Emory University School of Medicine, 6000 Woodruff Memorial Building, P.O. Drawer V, Atlanta, GA 30322.
We conducted a retrospective, multicenter study to compare the efficacy of warfarin with aspirin for the prevention of major vascular events (ischemic stroke, myocardial infarction, or sudden death) in patients with symptomatic stenosis of a major intracranial artery.Patients with 50 to 99% stenosis of an intracranial artery (carotid; anterior, middle, or posterior cerebral; vertebral; or basilar) were identified by reviewing the results of consecutive angiograms performed at participating centers between 1985 and 1991. Only patients with TIA or stroke in the territory of the stenotic artery qualified for inclusion in the study. Patients were prescribed warfarin or aspirin according to local physician preference and were followed by chart review and personal or telephone interview. Seven centers enrolled 151 patients; 88 were treated with warfarin and 63 were treated with aspirin. Median follow-up was 14.7 months (warfarin group) and 19.3 months (aspirin group). Vascular risk factors and mean percent stenosis of the symptomatic artery were similar in the two groups, yet the rates of major vascular events were 18.1 per 100 patient-years of follow-up in the aspirin group (stroke rate, 10.4/100 patient-years; myocardial infarction or sudden death rate, 7.7/100 patient-years) compared with 8.4 per 100 patient-years of follow-up in the warfarin group (stroke rate, 3.6/100 patient-years; myocardial infarction or sudden death rate, 4.8/100 patient-years). Kaplan-Meier analysis showed a significantly higher percentage of patients free of major vascular events among patients treated with warfarin (p equals 0.01). The relative risk of a major vascular event in those treated with warfarin was 0.46 (95% CI, 0.23 to 0.86) compared with patients treated with aspirin. Major hemorrhagic complications occurred in three patients on warfarin (including two deaths) during 166 patient-years of follow-up and in none of the patients on aspirin during 143 patient-years of follow-up. This study suggests a favorable risk/benefit ratio for warfarin compared with aspirin for the prevention of major vascular events in patients with symptomatic intracranial large-artery stenosis. A prospective, randomized study is needed to confirm these findings.
NEUROLOGY 1995;45: 1488-1493
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R. J. Wityk, H. M. Chang, A. Rosengart, W.-C. Han, L. D. DeWitt, M. S. Pessin, and L. R. Caplan Proximal Extracranial Vertebral Artery Disease in the New England Medical Center Posterior Circulation Registry Arch Neurol, April 1, 1998; 55(4): 470 - 478. [Abstract] [Full Text] [PDF]
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T. Segura, J. Serena, A. Molins, and A. Davalos Clusters of Microembolic Signals: A New Form of Cerebral Microembolism Presentation in a Patient With Middle Cerebral Artery Stenosis Stroke, March 1, 1998; 29(3): 722 - 724. [Abstract] [Full Text] [PDF]
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P. T. Akins, T. K. Pilgram, D. T. Cross III, and C. J. Moran Natural History of Stenosis From Intracranial Atherosclerosis by Serial Angiography Stroke, February 1, 1998; 29(2): 433 - 438. [Abstract] [Full Text] [PDF]
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U. Sliwka, C. Klotzsch, O. Popescu, K. Brandt, P. Schmidt, P. Berlit, and J. Noth Do Chronic Middle Cerebral Artery Stenoses Represent an Embolic Focus? : A Multirange Transcranial Doppler Study Stroke, July 1, 1997; 28(7): 1324 - 1327. [Abstract] [Full Text]
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R. J. Wityk, D. Lehman, M. Klag, J. Coresh, H. Ahn, and B. Litt Race and Sex Differences in the Distribution of Cerebral Atherosclerosis Stroke, November 1, 1996; 27(11): 1974 - 1980. [Abstract] [Full Text]
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D. G. Nabavi, D. Georgiadis, T. Mumme, P. Zunker, and E. B. Ringelstein Detection of Microembolic Signals in Patients With Middle Cerebral Artery Stenosis by Means of a Bigate Probe: A Pilot Study Stroke, August 1, 1996; 27(8): 1347 - 1349. [Abstract] [Full Text]
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K.S. Wong, W. W.M. Lam, E. Liang, Y.N. Huang, Y.L. Chan, and R. Kay Variability of Magnetic Resonance Angiography and Computed Tomography Angiography in Grading Middle Cerebral Artery Stenosis Stroke, June 1, 1996; 27(6): 1084 - 1087. [Abstract] [Full Text]
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