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August 22, 2000

Symptomatic intracranial atherosclerosis
Outcome of patients who fail antithrombotic therapy

August 22, 2000 issue
55 (4) 490-498

Abstract

Objective: To determine the prognosis of patients with symptomatic intracranial atherosclerosis who fail antithrombotic therapy.
Background: The outcome of patients with symptomatic intracranial atherosclerosis who fail antithrombotic therapy is unknown. These patients may represent the target group for investigation of more aggressive therapies such as intracranial angioplasty.
Methods: The authors performed a chart review and telephone interview of patients with symptomatic intracranial atherosclerosis identified in the Stanford Stroke Center clinical database. A Cox regression model was created to identify factors predictive of failure of antithrombotic therapy. The authors generated Kaplan–Meier survival curves to determine the timing of recurrent TIA, stroke, or death after failure of antithrombotic therapy.
Results: Fifty-two patients had symptomatic intracranial atherosclerosis and fulfilled entry criteria. Twenty-nine of the 52 patients (55.8%) had cerebral ischemic events while receiving an antithrombotic agent (antiplatelet agents [55%], warfarin [31%], or heparin [14%]). In a Cox regression model, older age was an independent predictor of failure of antithrombotic therapy, and warfarin use was associated with a decrease in risk. Recurrent TIA (n = 7), nonfatal/fatal stroke (n = 6/1), or death (n = 1) occurred in 15 of 29 (51.7%) of the patients who failed antithrombotic therapy. The median time to recurrent TIA, stroke, or death was 36 days (95% CI 13 to 59).
Conclusions: Patients with symptomatic intracranial atherosclerosis who fail antithrombotic therapy have extremely high rates of recurrent TIA/stroke or death. Recurrent ischemic events typically occur within a few months after failure of standard medical therapy. The high recurrence risk observed warrants testing of alternative treatment strategies such as intracranial angioplasty.

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Information & Authors

Information

Published In

Neurology®
Volume 55Number 4August 22, 2000
Pages: 490-498
PubMed: 10953179

Publication History

Received: March 15, 2000
Accepted: April 26, 2000
Published online: August 22, 2000
Published in print: August 22, 2000

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Authors

Affiliations & Disclosures

Vincent N. Thijs, MD
From the Stanford Stroke CenterDepartment of Neurology and Neurological Sciences, Stanford University Medical Center, Palo Alto, CA.
Gregory W. Albers, MD
From the Stanford Stroke CenterDepartment of Neurology and Neurological Sciences, Stanford University Medical Center, Palo Alto, CA.

Notes

Address correspondence and reprint requests to Dr. V.N. Thijs, Stanford Stroke Center, Stanford University Medical Center, 701 Welch Rd., Bldg. B, Suite 325, Palo Alto, CA 94304-0117; e-mail: [email protected]

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