Frequency and patterns of Brain Infarction in Patients With Embolic Stroke of Undetermined Source: NAVIGATE ESUS Trial
Por:
Sharma, M, Smith, EE, Pearce, LA, Shoamanesh, A, Perera, KS, Coutts, SB, Damgaard, D, Ameriso, SF, Rha, JH, Modrau, B, Yoon, BW, Romano, M, Messe, SR, Barlinn, J, Lambeck, J, Saad, F, Berkowitz, SD, Mundl, H, Connolly, SJ, Hart, RG, Marti-Fabregas, J, O'Donnell, MJ
Publicada:
1 ene 2022
Resumen:
BACKGROUND AND PURPOSE: The spectrum of brain infarction in patients with embolic stroke of undetermined source (ESUS) has not been well characterized. Our objective was to define the frequency and pattern of brain infarcts detected by magnetic resonance imaging (MRI) among patients with recent ESUS participating in a clinical trial.
METHODS: In the NAVIGATE ESUS trial (New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial Versus ASA to Prevent Embolism in Embolic Stroke of Undetermined Source), an MRI substudy was carried out at 87 sites in 15 countries. Participants underwent an MRI using a specified protocol near randomization. Images were interpreted centrally by those unaware of clinical characteristics.
RESULTS: Among the 918 substudy cohort participants, the mean age was 67 years and 60% were men with a median (interquartile range) of 64 (26-115) days between the qualifying ischemic stroke and MRI. On MRI, 855 (93%) had recent or chronic brain infarcts that were multiple in 646 (70%) and involved multiple arterial territories in 62% (401/646). Multiple brain infarcts were present in 68% (510/755) of those without a history of stroke or transient ischemic attack before the qualifying ESUS. Prior stroke/transient ischemic attack (P<0.001), modified Rankin Scale score >0 (P<0.001), and current tobacco use (P<0.01) were associated with multiple infarcts. Topographically, large and/or cortical infarcts were present in 89% (757/855) of patients with infarcts, while in 11% (98/855) infarcts were exclusively small and subcortical. Among those with multiple large and/or cortical infarcts, 57% (251/437) had one or more involving a different vascular territory from the qualifying ESUS.
CONCLUSIONS: Most patients with ESUS, including those without prior clinical stroke or transient ischemic attack, had multiple large and/or cortical brain infarcts detected by MRI, reflecting a substantial burden of clinical stroke and covert brain infarction. Infarcts most frequently involved multiple vascular territories.
Filiaciones:
Sharma, M:
McMaster Univ, Populat Hlth Res Inst, Hamilton Hlth Sci, Dept Med Neurol, Hamilton, ON, Canada
Smith, EE:
Univ Calgary, Dept Clin Neurosci, Calgary, AB, Canada
Shoamanesh, A:
McMaster Univ, Populat Hlth Res Inst, Hamilton Hlth Sci, Dept Med Neurol, Hamilton, ON, Canada
Perera, KS:
McMaster Univ, Populat Hlth Res Inst, Hamilton Hlth Sci, Dept Med Neurol, Hamilton, ON, Canada
Coutts, SB:
Univ Calgary, Dept Clin Neurosci Radiol & Community Hlth Sci, Calgary, AB, Canada
Damgaard, D:
Aarhus Univ Hosp, Dept Neurol, Aarhus, Denmark
Ameriso, SF:
Inst Neurol Res FLENI, Buenos Aires, DF, Argentina
Rha, JH:
Inha Univ Hosp, Incheon, South Korea
Modrau, B:
Aalborg Univ Hosp, Dept Neurol, Aalborg, Denmark
Yoon, BW:
Seoul Natl Univ Hosp, Dept Neurol, Seoul, South Korea
Romano, M:
Ctr Estudios Med & Invest Clin Dr N Quirno, Dept Neurol, Buenos Aires, DF, Argentina
Messe, SR:
Univ Penn, Dept Neurol, Philadelphia, PA 19104 USA
Barlinn, J:
Tech Univ Dresden, Univ Hosp Carl Gustav Carus, Dept Neurol, Dresden, Germany
Lambeck, J:
Univ Klinikum Freiburg, Dept Neurol & Clin Neurophysiol, Freiburg, Germany
Saad, F:
McMaster Univ, Populat Hlth Res Inst, Hamilton Hlth Sci, Dept Med Neurol, Hamilton, ON, Canada
Mundl, H:
Bayer US LLC, Pharmaceut Clin Dev Thrombosis & Vasc Med, Whippany, NJ USA
Connolly, SJ:
Hamilton Hlth Sci, Populat Hlth Res Inst, Hamilton, ON, Canada
Hart, RG:
Hamilton Hlth Sci, Populat Hlth Res Inst, Hamilton, ON, Canada
Marti-Fabregas, J:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
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