Article
Author: Saia, Valentina ; Cenciarelli, Silvia ; Muscia, Francesco ; Guarino, Maria ; Candelaresi, Paolo ; Sanna, Alessandra ; Marcon, Michela ; Di Viesti, Pietro ; Volpi, Gino ; Mezzapesa, Domenico Maria ; Zedde, Marialuisa ; Rota, Eugenia ; Diamanti, Susanna ; Falcou, Anne ; Tassi, Rossana ; Mosconi, Maria Giulia ; De Santis, Federico ; Bavaro, Alessandra ; Zivelonghi, Cecilia ; Toni, Danilo ; De Angelis, Maria Vittoria ; Rinaldi, Giuseppe ; Pistoia, Francesca ; Moraru, Stefan ; La Spada, Salvatore ; Sacco, Simona ; Zini, Andrea ; Ruzza, Giampietro ; De Matteis, Eleonora ; Beccia, Mario ; Chiti, Alberto ; Caputi, Luigi ; Tassinari, Tiziana ; Bagnato, Maria Rosaria ; Cappellari, Manuel ; Terruso, Valeria ; Ricci, Stefano ; Bongioanni, Maria Roberta ; Pelliccioni, Giuseppe ; Frisullo, Giovanni ; Di Blasio, Francesco ; Anticoli, Sabrina ; Palmieri, Carmela ; Masato, Maela ; Barbarini, Leonardo ; Manobianca, Giovanni ; Andreone, Vincenzo ; Bedetti, Chiara ; Paci, Cristina ; Sanzaro, Enzo ; Caggiula, Marcella ; Tonon, Agnese ; Barone, Valentina ; Russo, Monia ; Petruzzellis, Marco ; Mannino, Marina ; Puglisi, Valentina ; Ferrandi, Delfina ; Mastrangelo, Vincenzo ; Tarletti, Roberto ; Sepe, Federica Nicoletta ; Leone, Ruggiero ; Roberti, Cinzia ; Querzani, Pietro ; Fortini, Alberto ; Cavallini, Anna ; Vinciguerra, Luisa ; Rinaldi, Claudia ; Inchingolo, Vincenzo ; Cupini, Letizia Maria ; Invernizzi, Paolo ; Paciaroni, Maurizio ; Diomedi, Marina ; Censori, Bruno ; Caggia, Emanuele Alessandro ; Foschi, Matteo ; De Boni, Antonella ; Acciarri, Maria Cristina ; Del Sette, Massimo ; Bonanni, Laura ; Pezzini, Alessandro ; Passarelli, Francesco ; Nencini, Patrizia ; Romoli, Michele ; Viticchi, Giovanna ; Grisendi, Ilaria ; Scaglione, Gaspare ; Orsucci, Daniele ; Ornello, Raffaele ; Padiglioni, Chiara
BACKGROUNDThe outcomes of minor ischemic stroke resulting from small artery occlusion (SAO-MIS) have not yet been characterized after dual antiplatelet treatment (DAPT) has become the standard of care. We provided updated figures on the short-term prognosis of SAO-MIS treated with early short-term DAPT and compared the outcomes of SAO-MIS versus non-SAO-MIS patients.METHODSThis is a prespecified sub-analysis from a prospective multicentric real-world study (READAPT, NCT05476081) including patients with minor (NIHSS≤5) non-cardioembolic ischemic stroke treated with DAPT. The primary outcome was a composite of 90-day symptomatic ischemic stroke or major cardiovascular events. Secondary outcomes were the 90-day ordinal distribution of modified Rankin Scale (mRS) scores, 90-day excellent functional outcome (mRS of 0 to 1), and 24-h early neurological deterioration (END). Safety outcomes were 90-day intracerebral hemorrhage, moderate-to-severe and any bleedings. All outcomes were compared between SAO-MIS and non-SAO-MIS patients.RESULTSWe included 678 MIS, of whom 253 (37.3 %) were SAO-related. At 90 days, 3 patients with SAO-MIS had primary outcome (1.2 % [95 % CI 0.2 %-3.5 %]), which were all SAO-related ischemic strokes. For the secondary outcomes, most SAO-MIS patients (n = 191, 75.5 %) had 90-day excellent functional outcome and 12 had 24-h END (4.7 % [95 % CI 2.5 %-8.3 %]). Referring to safety outcomes, 90-day intracerebral hemorrhage occurred only in one patient with SAO-MIS (0.4 % [95 % CI 0.0 %- 2.2 %]). Compared to non-SAO-MIS, the 90-day risk of recurrent vascular events was significantly lower among SAO-MIS (aHR 0.24 [95 % CI 0.08-0.68]; p = 0.007), while there were not significant differences in other secondary outcomes, nor in the risk of safety events.CONCLUSIONSOur findings show overall favorable short-term prognosis after SAO-MIS treated with DAPT. Future studies should investigate factors associated with residual stroke risk and long-term outcomes of SAO-MIS.