Evaluation of Intracranial Atherosclerotic Stenosis Burden, the Use of Dual Antiplatelet Therapy and Stroke Recurrence in Patients with Minor Stroke

Intracranial atherosclerotic stenosis (ICAS) is a primary cause of ischemic stroke, but it might not be the main predictor of stroke recurrence. A comprehensive assessment of dual antiplatelet therapy (DAPT) effectiveness via ICAS burden (ICASB) is crucial for patients with minor stroke. This prospective, multicenter cohort study included patients with minor (National Institutes of Health Stroke Scale score ≤5) stroke. The ICASB was determined by the degree and number of ICAS occurrences. The primary efficacy outcomes were all stroke types (ischemic or hemorrhagic). Ninety-day and 1-year follow-up evaluations were conducted. Among 3061 patients (age = 61.7 ± 12.0 years; males, 73.3%), 61.0% (n = 1868) received DAPT, and 39.0% (n = 1193) received single APT. Finally, 2900 and 2709 patients were included in the 90-day and 1-year outcome assessments, respectively. The primary outcome occurred in 242 patients (8.3%) at 90 days and 353 patients (13.0%) at the 1-year follow-up. In patients with high ICASB (but not those with low ICASB), compared with single APT, DAPT was associated with a lower recurrent stroke rate at the 90-day (weighted absolute risk difference, 7.3%; inverse probability of treatment weighted hazard ratio, 0.58; 95% CI, 0.39-0.87) and 1-year (weighted absolute risk difference, 3.9%; inverse probability of treatment weighted hazard ratio, 0.68; 95% CI, 0.45-1.03) follow-ups. Significant interactions were observed at the 90-day (Pinteraction = .021) and 1-year (Pinteraction = .086) follow-ups. Similar results were observed for the propensity score matched model. For minor stroke patients receiving APT, DAPT reduced stroke recurrence at 90 days in the high ICASB group but not in the low ICASB group. Unique identifier: ChiCTR1900025214.