Anticoagulation: is there still a role in atherothrombotic stroke?

Estol, Conrado J.; Pessin, Michael S.

doi:10.1161/01.str.21.5.820

Cited by 29 publications

(14 citation statements)

References 28 publications

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“…20 In contrast to the WASID trial, we observed low incidences of stroke and TIA in patients with MCA disease under treatment with anticoagulants, similar to previous observational studies. 16,39,40 Considering our results, one may conclude that, because of the benign natural course, platelet inhibitors are preferable in asymptomatic obstructions of the MCA, whereas anticoagulants may be beneficial in selected patients with symptomatic, high-grade MCA stenoses. The different study design, inclusion of patients with stenosis of any intracranial artery, the use of higher doses of aspirin, and the shorter observation time in the WASID trial may explain this discrepancy.…”

Section: Discussionmentioning

confidence: 76%

Stroke recurrences in patients with symptomatic vs asymptomatic middle cerebral artery disease

Kern¹,

Steinke²,

et al. 2005

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Section: Discussionmentioning

confidence: 76%

Stroke recurrences in patients with symptomatic vs asymptomatic middle cerebral artery disease

Kern¹,

Steinke²,

et al. 2005

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“…12 The purpose of the present study was to compare the efficacy and safety of warfarin with aspirin for preventing major vascular events (stroke, myocardial infarction [MI], or sudden death) in patients with symptomatic, angiographically proven intracranial large-artery stenosis.…”

mentioning

confidence: 99%

The Warfarin-Aspirin Symptomatic Intracranial Disease Study

et al. 1995

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We conducted a retrospective, multicenter study to compare the efficacy of warfarin with aspirin for the prevention of major vascular events (ischemic stroke, myocardial infarction, or sudden death) in patients with symptomatic stenosis of a major intracranial artery. Patients with 50 to 99% stenosis of an intracranial artery (carotid; anterior, middle, or posterior cerebral; vertebral; or basilar) were identified by reviewing the results of consecutive angiograms performed at participating centers between 1985 and 1991. Only patients with TIA or stroke in the territory of the stenotic artery qualified for inclusion in the study. Patients were prescribed warfarin or aspirin according to local physician preference and were followed by chart review and personal or telephone interview. Seven centers enrolled 151 patients; 88 were treated with warfarin and 63 were treated with aspirin. Median follow-up was 14.7 months (warfarin group) and 19.3 months (aspirin group). Vascular risk factors and mean percent stenosis of the symptomatic artery were similar in the two groups, yet the rates of major vascular events were 18.1 per 100 patient-years of follow-up in the aspirin group (stroke rate, 10.4/100 patient-years; myocardial infarction or sudden death rate, 7.7/100 patient-years) compared with 8.4 per 100 patient-years of follow-up in the warfarin group (stroke rate, 3.6/100 patient-years; myocardial infarction or sudden death rate, 4.8/100 patient-years). Kaplan-Meier analysis showed a significantly higher percentage of patients free of major vascular events among patients treated with warfarin (p = 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

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“…[12,14,36,47] If this regimen fails, extracranial-intracranial bypass surgery may be considered in selected patients. Pharmacological antiplatelet or anticoagulation therapy is currently considered the treatment of choice.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous transluminal angioplasty of intracranial artery stenosis: clinical results in 24 patients

Henkes²,

Weber³

et al. 1998

FOC

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Circumscribed stenotic lesions of the intracranial arteries can cause cerebral ischemia by hemodynamic and/or thromboembolic mechanisms. Anticoagulation therapy, antiplatelet therapy, and bypass surgery are treatment strategies that have no direct impact on the underlying lesion. This study summarizes the experience of a single institution at which percutaneous transluminal angioplasty (PTA) of intracranial atherosclerotic stenoses was performed. The authors performed a retrospective analysis of 24 consecutive patients. Their medical histories (cardiovascular risk factors, current clinical signs and symptoms and their duration, previous stroke[s], and medical treatment) were evaluated together with findings from previous imaging studies. The site and degree of the stenoses to be treated (target lesion) were identified with the use of ultrasound and angiography studies. Additional vascular stenoses were noted. Percutaneous transluminal angioplasty was performed using single-lumen balloon microcatheters with appropriate diameters. The results of PTA were correlated with angiographic and ultrasound findings and the clinical outcome. Significant cardiovascular risk factors and clinical signs and symptoms related to the target lesion that persisted despite medical treatment were identified in all patients except one. The duration of symptoms varied from several days to 8 months. Previous stroke had occurred in four patients. The degree of stenosis was classified as “high grade” in 10 patients and as “subtotal” in 14. The target lesion (stenosis) was located in the anterior circulation in eight patients (four in the internal carotid and four in the middle cerebral arteries). Stenoses of posterior circulation vessels were treated in 16 patients (nine vertebral, six basilar, and one posterior cerebral arteries). Recanalization was rated “complete” in 15 patients and sufficient in six patients. In three patients residual stenosis remained. Complications were encountered in seven patients: two asymptomatic dissections, one transient vessel occlusion, one vessel occlusion with subsequent stroke, and three ischemic lesions likely due to thromboembolism, two of which caused only transient neurological symptoms. Percutaneous balloon dilation proved effective in the treatment of intracranial atherosclerotic stenosis. There are, however, potential complications and experience with this procedure is only limited. Long-term results need to be determined. The authors conclude from their preliminary results that PTA may be an alternative to bypass surgery and conservative management and may be considered for patients in whom ischemic neurological symptoms persist despite medical treatment.

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Anticoagulation: is there still a role in atherothrombotic stroke?

Cited by 29 publications

References 28 publications

Stroke recurrences in patients with symptomatic vs asymptomatic middle cerebral artery disease

Stroke recurrences in patients with symptomatic vs asymptomatic middle cerebral artery disease

The Warfarin-Aspirin Symptomatic Intracranial Disease Study

Percutaneous transluminal angioplasty of intracranial artery stenosis: clinical results in 24 patients

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