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Reale G, Zauli A, La Torre G, Mannocci A, Mazya MV, Zedde M, Giovannini S, Moci M, Iacovelli C, Caliandro P. Dual anti-platelet therapy for secondary prevention in intracranial atherosclerotic disease: a network meta-analysis. Ther Adv Neurol Disord 2022; 15:17562864221114716. [PMID: 35958039 PMCID: PMC9358568 DOI: 10.1177/17562864221114716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Intracranial arterial stenosis (ICAS) is a non-marginal cause of stroke/transient ischemic attacks (TIAs) and is associated with high stroke recurrence rate. Some studies have investigated the best secondary prevention ranging from antithrombotic therapy to endovascular treatment (ET). However, no direct comparison between all the possible treatments is currently available especially between single and dual anti-platelet therapies (SAPT and DAPT). Aim: To establish whether DAPT is more effective than SAPT in preventing the recurrence of ICAS-related stroke, by means of a network meta-analysis (NMA). Design: Systematic review and NMA in accordance to PRISMA guidelines. Data sources and methods: We performed a systematic review of trials investigating secondary prevention (SAPT or DAPT, anticoagulant treatment or ET) in patients with symptomatic ICAS available in MEDLINE, Scopus and Web of Science from January 1989 to May 2021. We defined our primary efficacy outcome as the recurrence of ischemic stroke/TIA. We analysed the extracted data with Bayesian NMA approach. Results: We identified 815 studies and included 5 trials in the NMA. Sequence generation was adequate in all the selected studies while the allocation concealment method was described in one study. All the included studies reported the pre-specified primary outcomes, and outcome assessment was blinded in all the studies. We used the fixed-effect approach as the heterogeneity was not significant (p > 0.1) according to the Cochran’s Q statistic. DAPT was superior to SAPT and DAPT + ET in preventing stroke/TIA recurrence [respectively, odds ratio (OR), 0.59; confidence interval (CI), 0.39–0.9; and OR, 0.49, CI, 0.26–0.88], while no difference was found between DAPT and oral anticoagulant therapy (OAC). DAPT was safer than OAC (OR, 0.48; CI, 0.26–0.89) and DAPT + ET (OR, 0.50; CI, 0.35–0.71), while no difference was found between DAPT and SAPT. Conclusion: DAPT is more effective than SAPT for secondary stroke prevention in patients with symptomatic ICAS, without increasing the risk of haemorrhage. Registration: Prospero/CRD42019140033.
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Affiliation(s)
- Giuseppe Reale
- Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Aurelia Zauli
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe La Torre
- Department of Public Health and Infectious Disease, Sapienza/Policlinico Umberto I, Rome, Italy
| | - Alice Mannocci
- Faculty of Economics, Universitas Mercatorum, Rome, Italy
| | - Michael V Mazya
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Giovanni Amendola, 2, Reggio Emilia 42122, Italy
| | - Silvia Giovannini
- Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Moci
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Chiara Iacovelli
- Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Pietro Caliandro
- Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Xiao J, Song SS, Schlick KH, Xia S, Jiang T, Han T, Jackson RJ, Diniz MA, Dumitrascu OM, Maya MM, Lyden PD, Li D, Yang Q, Fan Z. Disparate trends of atherosclerotic plaque evolution in stroke patients under 18-month follow-up: a 3D whole-brain magnetic resonance vessel wall imaging study. Neuroradiol J 2022; 35:42-52. [PMID: 34159814 PMCID: PMC8826292 DOI: 10.1177/19714009211026920] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The trend of atherosclerotic plaque feature evolution is unclear in stroke patients with and without recurrence. We aimed to use three-dimensional whole-brain magnetic resonance vessel wall imaging to quantify the morphological changes of causative lesions during medical therapy in patients with symptomatic intracranial atherosclerotic disease. METHODS Patients with acute ischemic stroke attributed to intracranial atherosclerotic disease were retrospectively enrolled if they underwent both baseline and follow-up magnetic resonance vessel wall imaging. The morphological features of the causative plaque, including plaque volume, peak normalized wall index, maximum wall thickness, degree of stenosis, pre-contrast plaque-wall contrast ratio, and post-contrast plaque enhancement ratio, were quantified and compared between the non-recurrent and recurrent groups (defined as the recurrence of a vascular event within 18 months of stroke). RESULTS Twenty-nine patients were included in the final analysis. No significant differences were found in plaque features in the baseline scan between the non-recurrent (n = 22) and recurrent groups (n = 7). The changes in maximum wall thickness (-13.32% vs. 8.93%, P = 0.026), plaque-wall contrast ratio (-0.82% vs. 3.42%, P = 0.005) and plaque enhancement ratio (-11.03% vs. 9.75%, P = 0.019) were significantly different between the non-recurrent and recurrent groups. Univariable logistic regression showed that the increase in plaque-wall contrast ratio (odds ratio 3.22, 95% confidence interval 1.55-9.98, P = 0.003) was related to stroke recurrence. CONCLUSION Morphological changes of plaque features on magnetic resonance vessel wall imaging demonstrated distinct trends in symptomatic intracranial atherosclerotic disease patients with and without stroke recurrence.
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Affiliation(s)
- Jiayu Xiao
- Biomedical Imaging Research
Institute, Cedars-Sinai Medical Center, USA
| | - Shlee S Song
- Department of Neurology,
Cedars-Sinai Medical Center, USA
| | | | - Shuang Xia
- Department of Radiology, Tianjin
First Central Hospital, China
| | - Tao Jiang
- Department of Radiology, Beijing
Chaoyang Hospital, China
| | - Tong Han
- Department of Radiology, Tianjin
Huanhu Hospital, China
| | | | - Marcio A Diniz
- Biostatistics and Bioinformatics
Research Center, Cedars-Sinai Medical Center, USA
| | | | - Marcel M Maya
- Department of Imaging, Cedars-Sinai
Medical Center, USA
| | - Patrick D Lyden
- Department of Physiology and
Neuroscience, Zilkha Neurogenetic Institute, University of Southern California,
USA
| | - Debiao Li
- Biomedical Imaging Research
Institute, Cedars-Sinai Medical Center, USA,Department of Bioengineering,
University of California, Los Angeles, USA
| | - Qi Yang
- Department of Radiology, Beijing
Chaoyang Hospital, China
| | - Zhaoyang Fan
- Biomedical Imaging Research
Institute, Cedars-Sinai Medical Center, USA,Departments of Radiology and
Radiation Oncology, University of Southern California, USA,Zhaoyang Fan, 2250 Alcazar Street, Room
104, Los Angeles, CA, USA.
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Reale G, Alexandre A, Caliandro P. Letter by Reale et al Regarding Article, "Regional High Wall Shear Stress Associated With Stenosis Regression in Symptomatic Intracranial Atherosclerotic Disease". Stroke 2021; 52:e79. [PMID: 33493056 DOI: 10.1161/strokeaha.120.032934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Giuseppe Reale
- Università Cattolica del Sacro Cuore, Department of Geriatrics, Neurosciences and Orthopedics, Roma, Italia (G.R.)
| | - Andrea Alexandre
- UOC Radiologia e Neuroradiologia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia (A.A.), Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Pietro Caliandro
- Unità Operativa Complessa Neurologia (P.C.), Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
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Lan L, Liu H, Leung TW, Leng X. Response by Lan et al to Letter Regarding Article, "Regional High Wall Shear Stress Associated With Stenosis Regression in Symptomatic Intracranial Atherosclerotic Disease". Stroke 2021; 52:e80-e81. [PMID: 33493054 DOI: 10.1161/strokeaha.120.033341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Linfang Lan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, China (L.L., T.W.L., X.L.).,Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China (L.L.)
| | - Haipeng Liu
- Research Centre of Intelligent Healthcare, Faculty of Health and Life Science, Coventry University, United Kingdom (H.L.)
| | - Thomas W Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, China (L.L., T.W.L., X.L.)
| | - Xinyi Leng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, China (L.L., T.W.L., X.L.)
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The role of carotid stenosis ultrasound scale in the prediction of ischemic stroke. Neurol Sci 2020; 41:1193-1199. [PMID: 31901124 PMCID: PMC7196942 DOI: 10.1007/s10072-019-04204-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/17/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION To improve the accuracy of ultrasound techniques for the assessment of carotid stenosis, we designed a novel carotid artery stenosis ultrasound scale (CASUS), and evaluated its accuracy, reliability, and its value in predicting the occurrence of cardiovascular and cerebrovascular diseases in a prospective study. METHODS A total of 750 patients with first-time ischemic stroke and hospitalized within 24 h were enrolled in the study. Using color Doppler ultrasound (CDUS), the degree of stenosis and blood flow (BF) in bilateral internal carotid arteries (ICA) and the V1-V3 segment of vertebral arteries (VA) was assessed. Cubic simulation curves for BF and global blood flow (GBF) over the stenosis score (SS), total stenosis score (TSS), and radiological imaging- total stenosis score (RI-TSS) were fitted and compared. The receiver operating characteristic (ROC) curves using TSS, RI-TSS, or GBF to predict various ischemic stroke endpoints were also analyzed and compared. RESULTS There was a linear relationship between SS and BF both ICA and VA (R2 were 0.734 and 0.783, respectively, both P < 0.05). Both TSS and RI-TSS with GBF showed an inverse "S" curve relationship (R2 was 0.839 and 0.843, all P < 0.05). The AUC values of TSS-based and RI-TSS-based predictions of each endpoint were all greater than 0.7 (all P < 0.05), but the differences of the AUC values between TSS, RI-TSS, and GBF were not statistically significant (all P > 0.05). CONCLUSIONS The novel CASUS can better reflect the level of cerebral reperfusion in patients with ischemic stroke and can better predict the occurrence of cardiovascular and cerebrovascular diseases.
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Reale G, Giovannini S, Caliandro P. Letter by Reale et al Regarding Article, "Hemodynamic Markers in the Anterior Circulation as Predictors of Recurrent Stroke in Patients With Intracranial Stenosis". Stroke 2019; 50:e129. [PMID: 30890113 DOI: 10.1161/strokeaha.118.024760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Giuseppe Reale
- Institute of Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvia Giovannini
- Unità Operativa Complessa Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Pietro Caliandro
- Unità Operativa Complessa di Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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