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Microbleeds in the Secondary Prevention of Small Subcortical Strokes Trial: Stroke, mortality, and treatment interactions
Journal article   Open access   Peer reviewed

Microbleeds in the Secondary Prevention of Small Subcortical Strokes Trial: Stroke, mortality, and treatment interactions

Ashkan Shoamanesh, Lesly A Pearce, Carlos Bazan, Luciana Catanese, Leslie A McClure, Mukul Sharma, Joan Marti-Fabregas, David C Anderson, Carlos S Kase, Robert G Hart, …
Annals of neurology, v 82(2)
Aug 2017
DOI: https://doi.org/10.1002/ana.24988
PMID: 28681535
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://europepmc.org/articles/pmc5568949View
Accepted (AM),  Open

Abstract

Aspirin - therapeutic use Cerebral Hemorrhage - complications Cerebral Hemorrhage - mortality Cerebral Hemorrhage - prevention & control Double-Blind Method Female Humans Magnetic Resonance Imaging Male Middle Aged Platelet Aggregation Inhibitors - therapeutic use Recurrence Risk Factors Secondary Prevention - methods Stroke, Lacunar - complications Stroke, Lacunar - diagnostic imaging Stroke, Lacunar - prevention & control Ticlopidine - analogs & derivatives Ticlopidine - therapeutic use
To characterize cerebral microbleeds (CMBs) in lacunar stroke patients in the Secondary Prevention of Small Subcortical Strokes (SPS3) trial and to assess their relationship with recurrent stroke and death, and response to assigned treatment. SPS3 is a randomized, clinical trial conducted between 2003 and 2011. Patients with recent magnetic resonance imaging (MRI)-documented lacunar infarcts were randomly assigned in a factorial design to target levels of systolic blood pressure (130-149mmHg vs <130mmHg; open label) and to antiplatelet treatment (aspirin/clopidogrel vs aspirin/placebo; double-blinded). The current analysis involves 1,278 trial participants who had a baseline axial T2*-weighted gradient echo MRI sequence allowing for CMB detection. CMBs were present in 30% of 1,278 patients (mean age = 63 years). Male gender (odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.3-2.3), history of hypertension (OR = 1.6, 95% CI = 1.2-2.3), increased systolic blood pressure (1.2 per 20mmHg, 95% CI = 1.1-1.4), nondiabetic status (OR = 1.4, 95% CI = 1.1-1.9), multiple old lacunar infarcts (OR = 1.9, 95% CI = 1.5-2.5), and moderate (OR = 1.7, 95% CI = 1.2-2.3) or severe (OR = 4.2, 95% CI = 3.0-5.9) white matter hyperintensities on MRI were independently associated with CMBs. During a mean follow-up of 3.3 years, overall stroke recurrence was 2.5% per patient-year. Patients with CMBs had an adjusted 2-fold increased risk of recurrent stroke (hazard ratio = 2.1, 95% CI = 1.4-3.1). CMBs were not a risk factor for death. There were no statistically significant interactions between CMBs and treatment assignments. Patients with lacunar stroke and CMBs likely harbor a more advanced form of cerebral small vessel disease in need of efficacious therapeutic strategies. Ann Neurol 2017;82:196-207.

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44 citations in Scopus

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Collaboration types
Domestic collaboration
International collaboration
Web of Science research areas
Clinical Neurology
Neurosciences
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