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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


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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Sacco RL, Kargman DE, Gu Q, Zamanillo MC. Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study. Stroke 1995;26:14–20.
Wityk RJ, Lehman D, Klag M, Coresh J, Ahn H, Litt B. Race and sex differences in the distribution of cerebral atherosclerosis. Stroke 1996;27:1974–1980.
The Extracranial Intracranial Bypass Study Group.Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. N Engl J Med 1985;313:1191–1200.
Bogousslavsky J, Barnett HJ, Fox AJ, Hachinski VC, Taylor W. Atherosclerotic disease of the middle cerebral artery. Stroke 1986;17:1112–1120.
Chimowitz MI, Kokkinos J, Strong J, et al. The Warfarin-Aspirin Symptomatic Intracranial Disease Study. Neurology 1995;45:1488–1493.
Major ongoing stroke trials. Warfarin versus Aspirin for Intracranial Disease. Stroke 1999;30:2256–2261.
Marks MP, Marcellus M, Norbash AM, Steinberg GK, Tong D, Albers GW. Outcome of angioplasty for atherosclerotic intracranial stenosis. Stroke 1999;30:1060–1069.
Kellogg JX, Nesbit GM, Clark WM, Barnwell SL. The role of angioplasty in the treatment of cerebrovascular disease. Neurosurgery 1998;43:549–556.
Clark WM, Barnwell SL, Nesbit G, O’Neill OR, Wynn ML, Coull BM. Safety and efficacy of percutaneous transluminal angioplasty for intracranial atherosclerotic stenosis. Stroke 1995;26:1200–1204.
Connors JJ III, Wojak JC. Percutaneous transluminal angioplasty for intracranial atherosclerotic lesions: evolution of technique and short-term results. J Neurosurg 1999;91:415–423.
Callahan AS III, Berger BL. Balloon angioplasty of intracranial arteries for stroke prevention. J Neuroimag 1997;7:232–235.
Gorelick PB. Cerebrovascular disease in African Americans. Stroke 1998;29:2656–2564.
Caplan LR, Gorelick PB, Hier DB. Race, sex and occlusive cerebrovascular disease: a review. Stroke 1986;17:648–655.
Wong KS, Huang YN, Gao S, Lam WWM, Chan YL, Kay R. Intracranial stenosis in Chinese patients with acute stroke. Neurology 1998;50:812–813.
Hass WK, Easton JD, Adams HP Jr, et al. A randomized trial comparing ticlopidine hydrochloride with aspirin for the prevention of stroke in high-risk patients. Ticlopidine Aspirin Stroke Study Group. N Engl J Med 1989;321:501–507.
Grotta JC, Norris JW, Kamm B. Prevention of stroke with ticlopidine: who benefits most? TASS Baseline and Angiographic Data Subgroup. Neurology 1992;42:111–115.
Albers GW, Easton DJ, Sacco RL, Teal P. Antithrombotic and thrombolytic therapy for ischemic stroke. Chest 1998;114:683S–698S.
Marzewski DJ, Furlan AJ, St. Louis P, Little JR, Modic MT, Williams G. Intracranial internal carotid artery stenosis: long-term prognosis. Stroke 1982;13:821–824.
Wechsler LR, Kistler JP, Davis KR, Kaminski MJ. The prognosis of carotid siphon stenosis. Stroke 1986;17:714–718.
Craig DR, Meguro K, Watridge C, Robertson JT, Barnett HJM, Fox AJ. Intracranial internal carotid artery stenosis. Stroke 1982;13:825–828.
Borozan PG, Schuler JJ, LaRosa MP, Ware MS, Flanigan DP. The natural history of isolated carotid siphon stenosis. J Vasc Surg 1984;1:744–749.
Hinton RC, Mohr JP, Ackerman RH, Adair LB, Fisher CM. Symptomatic middle cerebral artery stenosis. Ann Neurol 1979;5:152–157.
Corston RN, Kendall BE, Marshall J. Prognosis in middle cerebral artery stenosis. Stroke 1984;15:237–241.
Moufarrij NA, Little JR, Furlan AJ, Leatherman JR, Williams GW. Basilar and distal vertebral artery stenosis: long term follow-up. Stroke 1986;17:938–942.
Pessin MS, Gorelick PB, Kwan ES, Caplan LR. Basilar artery stenosis: middle and distal segments. Neurology 1987;37:1742–1746.
Pessin MS, Kwan ES, DeWitt LD, Hedges TR, Gale D, Caplan LR. Posterior cerebral artery stenosis. Ann Neurol 1987;21:85–89.
Wentz KU, Rother J, Schwartz A, Mattle HP, Suchalla R, Edelman RR. Intracranial vertebrobasilar system: MR angiography. Radiology 1994;190:105–110.
Stock KW, Radue EW, Jacob AL, Bao XS, Steinbrich W. Intracranial arteries: prospective blinded comparative study of MR angiography and DSA in 50 patients. Radiology 1995;195:451–456.
Korogi Y-TM, Mabuchi N, Miki H, et al. Intracranial vascular stenosis and occlusion: diagnostic accuracy of three-dimensional, Fourier transform, time-of-flight MR angiography. Radiology 1994;193:187–193.
Rorick MB, Nichols FT, Adams RJ. Transcranial Doppler correlation with angiography in detection of intracranial stenosis. Stroke 1994;25:1931–1934.
Ley-Pozo J, Ringelstein EB. Noninvasive detection of occlusive disease of the carotid siphon and middle cerebral artery. Ann Neurol 1990;28:640–647.
Felberg RA, Demchuk AM, Kim Y, Wein TH, Grotta J, Alexandrov AV. Screening for intracranial stenosis: the positive predictive value of transcranial Doppler velocity thresholds. Stroke 2000;31:275–346. Abstract.
Barnett HJ, Taylor DW, Eliasziw M, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 1998;339:1415–1425.

Information & Authors


Published In

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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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.


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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