Prevalence and Effect of Cerebral Small Vessel Disease in Stroke Patients With Aspirin Treatment Failure–A Hospital-Based Stroke Secondary Prevention Registry

Background: Breakthrough strokes during treatment with aspirin, termed clinical aspirin treatment failure (ATF), is common in clinical practice. The burden of cerebral small vessel disease (SVD) is associated with an increased recurrent ischemic stroke risk. However, the association between SVD and...

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Main Authors: Ping-Song Chou, Pi-Shan Sung, Chi-Hung Liu, Yueh-Feng Sung, Ray-Chang Tzeng, Chun-Pai Yang, Chi-Hsun Lien, Helen L. Po, Shang-Chang Ho, Yi-Te Tsai, Tsang-Shan Chen, Shey-Lin Wu, Han-Hwa Hu, A-Ching Chao
Format: Article
Language:English
Published: Frontiers Media S.A. 2021-04-01
Series:Frontiers in Neurology
Subjects:
Online Access:https://www.frontiersin.org/articles/10.3389/fneur.2021.645444/full
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author Ping-Song Chou
Ping-Song Chou
Pi-Shan Sung
Chi-Hung Liu
Chi-Hung Liu
Yueh-Feng Sung
Ray-Chang Tzeng
Chun-Pai Yang
Chun-Pai Yang
Chi-Hsun Lien
Helen L. Po
Shang-Chang Ho
Yi-Te Tsai
Tsang-Shan Chen
Shey-Lin Wu
Han-Hwa Hu
Han-Hwa Hu
Han-Hwa Hu
A-Ching Chao
A-Ching Chao
author_facet Ping-Song Chou
Ping-Song Chou
Pi-Shan Sung
Chi-Hung Liu
Chi-Hung Liu
Yueh-Feng Sung
Ray-Chang Tzeng
Chun-Pai Yang
Chun-Pai Yang
Chi-Hsun Lien
Helen L. Po
Shang-Chang Ho
Yi-Te Tsai
Tsang-Shan Chen
Shey-Lin Wu
Han-Hwa Hu
Han-Hwa Hu
Han-Hwa Hu
A-Ching Chao
A-Ching Chao
author_sort Ping-Song Chou
collection DOAJ
description Background: Breakthrough strokes during treatment with aspirin, termed clinical aspirin treatment failure (ATF), is common in clinical practice. The burden of cerebral small vessel disease (SVD) is associated with an increased recurrent ischemic stroke risk. However, the association between SVD and ATF remains unclear. This study investigated the prevalence and clinical characteristics of SVD in stroke patients with ATF.Methods: Data from a prospective, and multicenter stroke with ATF registry established in 2018 in Taiwan were used, and 300 patients who developed ischemic stroke concurrent with regular use of aspirin were enrolled. White matter lesions (WMLs) and cerebral microbleeds (CMBs) were identified using the Fazekas scale and Microbleed Anatomical Rating Scale, respectively. Demographic data, cardiovascular comorbidities, and index stroke characteristics of patients with different WML and CMB severities were compared. Logistic regression analyses were performed to explore the factors independently associated with outcomes after ATF.Results: The mean patient age was 69.5 ± 11.8 years, and 70.0% of patients were men. Among all patients, periventricular WML (PVWML), deep WML (DWML), and CMB prevalence was 93.3, 90.0, and 52.5%, respectively. Furthermore, 46.0% of the index strokes were small vessel occlusions. Severe PVWMLs and DWMLs were significantly associated with high CMB burdens. Patients with moderate-to-severe PVWMLs and DWMLs were significantly older and had higher cardiovascular comorbidity prevalence than did patients with no or mild WMLs. Moreover, patients with favorable outcomes exhibited significantly low prevalence of severe PVWMLs (p = 0.001) and DWMLs (p = 0.001). After logistic regression was applied, severe WMLs predicted less favorable outcomes independently, compared with those with no to moderate PVWMLs and DWMLs [odds ratio (OR), 0.47; 95% confidence interval (CI), 0.25–0.87 for severe PVWMLs; OR, 0.40; 95% CI, 0.21–0.79 for severe DWMLs].Conclusions: SVD is common in stroke patients with ATF. PVWMLs and DWMLs are independently associated with functional outcomes in stroke patients with ATF. The burden of SVD should be considered in future antiplatelet strategies for stroke patients after ATF.
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spelling doaj.art-5d695f4840c74e71ac4f6f3474a25c3f2022-12-21T21:29:31ZengFrontiers Media S.A.Frontiers in Neurology1664-22952021-04-011210.3389/fneur.2021.645444645444Prevalence and Effect of Cerebral Small Vessel Disease in Stroke Patients With Aspirin Treatment Failure–A Hospital-Based Stroke Secondary Prevention RegistryPing-Song Chou0Ping-Song Chou1Pi-Shan Sung2Chi-Hung Liu3Chi-Hung Liu4Yueh-Feng Sung5Ray-Chang Tzeng6Chun-Pai Yang7Chun-Pai Yang8Chi-Hsun Lien9Helen L. Po10Shang-Chang Ho11Yi-Te Tsai12Tsang-Shan Chen13Shey-Lin Wu14Han-Hwa Hu15Han-Hwa Hu16Han-Hwa Hu17A-Ching Chao18A-Ching Chao19Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, TaiwanDepartment of Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanDepartment of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, TaiwanDepartment of Neurology, Stroke Center, Linkou Chang Gung Memorial Hospital, Taoyuan, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanDepartment of Neurology, National Defense Medical Center, Tri-Service General Hospital, Taipei, TaiwanDepartment of Neurology, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, TaiwanDepartment of Neurology, Kuang Tien General Hospital, Taichung, TaiwanDepartment of Nutrition, Huang-Kuang University, Taichung, Taiwan0Department of Neurology, Tungs' Taichung Metro Harbor Hospital, Taichung, Taiwan1Department of Neurology, Stroke Center, MacKay Memorial Hospital, Taipei, TaiwanDepartment of Neurology, Kuang Tien General Hospital, Taichung, Taiwan2Department of Neurology, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan3Department of Neurology, Sin-Lau Hospital, The Presbyterian Church of Taiwan, Tainan, Taiwan4Department of Neurology of Changhua Christian Hospital, Changhua, Taiwan5Department of Neurology, Taipei Medical University-Shaung Ho Hospital, Taipei, Taiwan6Beijing Tiantan Hospital, Capital Medical University, Beijing, China7Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, ChinaDepartment of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, TaiwanDepartment of Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanBackground: Breakthrough strokes during treatment with aspirin, termed clinical aspirin treatment failure (ATF), is common in clinical practice. The burden of cerebral small vessel disease (SVD) is associated with an increased recurrent ischemic stroke risk. However, the association between SVD and ATF remains unclear. This study investigated the prevalence and clinical characteristics of SVD in stroke patients with ATF.Methods: Data from a prospective, and multicenter stroke with ATF registry established in 2018 in Taiwan were used, and 300 patients who developed ischemic stroke concurrent with regular use of aspirin were enrolled. White matter lesions (WMLs) and cerebral microbleeds (CMBs) were identified using the Fazekas scale and Microbleed Anatomical Rating Scale, respectively. Demographic data, cardiovascular comorbidities, and index stroke characteristics of patients with different WML and CMB severities were compared. Logistic regression analyses were performed to explore the factors independently associated with outcomes after ATF.Results: The mean patient age was 69.5 ± 11.8 years, and 70.0% of patients were men. Among all patients, periventricular WML (PVWML), deep WML (DWML), and CMB prevalence was 93.3, 90.0, and 52.5%, respectively. Furthermore, 46.0% of the index strokes were small vessel occlusions. Severe PVWMLs and DWMLs were significantly associated with high CMB burdens. Patients with moderate-to-severe PVWMLs and DWMLs were significantly older and had higher cardiovascular comorbidity prevalence than did patients with no or mild WMLs. Moreover, patients with favorable outcomes exhibited significantly low prevalence of severe PVWMLs (p = 0.001) and DWMLs (p = 0.001). After logistic regression was applied, severe WMLs predicted less favorable outcomes independently, compared with those with no to moderate PVWMLs and DWMLs [odds ratio (OR), 0.47; 95% confidence interval (CI), 0.25–0.87 for severe PVWMLs; OR, 0.40; 95% CI, 0.21–0.79 for severe DWMLs].Conclusions: SVD is common in stroke patients with ATF. PVWMLs and DWMLs are independently associated with functional outcomes in stroke patients with ATF. The burden of SVD should be considered in future antiplatelet strategies for stroke patients after ATF.https://www.frontiersin.org/articles/10.3389/fneur.2021.645444/fullaspirin treatment failurecerebral small vessel diseasemicrobleedstrokewhite matter lesion
spellingShingle Ping-Song Chou
Ping-Song Chou
Pi-Shan Sung
Chi-Hung Liu
Chi-Hung Liu
Yueh-Feng Sung
Ray-Chang Tzeng
Chun-Pai Yang
Chun-Pai Yang
Chi-Hsun Lien
Helen L. Po
Shang-Chang Ho
Yi-Te Tsai
Tsang-Shan Chen
Shey-Lin Wu
Han-Hwa Hu
Han-Hwa Hu
Han-Hwa Hu
A-Ching Chao
A-Ching Chao
Prevalence and Effect of Cerebral Small Vessel Disease in Stroke Patients With Aspirin Treatment Failure–A Hospital-Based Stroke Secondary Prevention Registry
Frontiers in Neurology
aspirin treatment failure
cerebral small vessel disease
microbleed
stroke
white matter lesion
title Prevalence and Effect of Cerebral Small Vessel Disease in Stroke Patients With Aspirin Treatment Failure–A Hospital-Based Stroke Secondary Prevention Registry
title_full Prevalence and Effect of Cerebral Small Vessel Disease in Stroke Patients With Aspirin Treatment Failure–A Hospital-Based Stroke Secondary Prevention Registry
title_fullStr Prevalence and Effect of Cerebral Small Vessel Disease in Stroke Patients With Aspirin Treatment Failure–A Hospital-Based Stroke Secondary Prevention Registry
title_full_unstemmed Prevalence and Effect of Cerebral Small Vessel Disease in Stroke Patients With Aspirin Treatment Failure–A Hospital-Based Stroke Secondary Prevention Registry
title_short Prevalence and Effect of Cerebral Small Vessel Disease in Stroke Patients With Aspirin Treatment Failure–A Hospital-Based Stroke Secondary Prevention Registry
title_sort prevalence and effect of cerebral small vessel disease in stroke patients with aspirin treatment failure a hospital based stroke secondary prevention registry
topic aspirin treatment failure
cerebral small vessel disease
microbleed
stroke
white matter lesion
url https://www.frontiersin.org/articles/10.3389/fneur.2021.645444/full
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