Citations 2
Abstract DP310: Dual Antiplatelet versus Anticoagulant-Plus-Antiplatelet Therapy in Symptomatic Intracranial Atherosclerosis: A Multicenter Comparative Study
Rehman, M. Aemaz Ur, Yaghi, Shadi, Kasab, Sami Al, Qdais, Ahmad Abu, Yaddanapudi, Sridhara , Sultana, Sabiha , Khan, Muhib, Malik, Maarij , Klaas, James P. , Guerrero, Christopher Leon, Velez, Faddi Saleh, Pinto, Camila, McCullough-Hicks, Margy, Cooper, Dawson C , Pillai, Abhiram Parameswaran, Hariharan, Praveen, Alam, Shaista , Antonenko, Kateryna, Almiri, William , Rothstein, Aaron, Krishnaiah, Balaji , Elangovan, Cheran, Agarwal, Ayush, Romoli, Michele, Nicola, Marrone, Vozzi, Stefano, Ghannam, Malik, Dibas, Mahmoud I., Marto, Joao Pedro, AlMajali, Mohammad, Sousa, Diana Aguiar de, Soares, Mafalda Delgado, Lima, Anicléia Rodrigues de, Tountopoulou, Argyro , Havenon, Adam de, Henninger, Nils, Helenius, Johanna, Khasawneh, Mohammad W , Klein, Piers, Shu, Liqi , Khatri, Pooja, Nguyen, Thanh N., Liebeskind, D, Bakradze, Ekaterina, Henninger, Nils , Sousa, Diana Aguiar de , Henninger, Nils , Aguiar de Sousa, Diana , Khan, Fahad , Yaghi, Shadi , Kasab, Sami Al , Sultana, Sabiha, Khan, Muhib , Leon Guerrero, Christopher R , Velez, Faddi G. Saleh , Owens, Cameron , Pinto, Camila, McCullough‐Hicks, Margy , Hariharan, Praveen , Alam, Shaista, Heldner, Mirjam R. , Antonenko, Kateryna , Rothstein, Aaron , Elangovan, Cheran , Romoli, Michele , Marrone, Nicola , Ghannam, Malik , Dibas, Mahmoud, Marto, João Pedro , Simpkins, Alexis N. , Soares, Mafalda , Lima, Amanda, Siegler, James E. , VASILOPOULOU, SOFIA, Klein, Piers , Bakradze, Ekaterina
Stroke | January 29, 2026 | Volume: 57 | Issue: Suppl_1 | Pages: No page available
Introduction: Intracranial atherosclerosis (ICAS) is a leading cause of ischemic stroke (IS) worldwide and carries a high risk of recurrence. Current guidelines favor 90 days of dual antiplatelet therapy (DAPT) for severe symptomatic ICAS, but recurrence remain high. Limited data suggest possible benefit of single antiplatelet plus anticoagulation (SAPT+AC). We compared the effectiveness and safety of DAPT versus SAPT+AC. We hypothesized that DAPT would lower 90-day recurrent IS risk without significantly increasing bleeding. Methods: This substudy of the Biomarkers and Recurrence Risk in Symptomatic Intracranial Arterial Stenosis (BIORISK-ICAS) included patients from 35 centers (Jan 2019–Jun 2024) with symptomatic 50–99% ICAS in the intracranial internal carotid, vertebral, basilar, or M1 segment of the MCA, presenting ≤72 hours from last known well. The primary efficacy outcome was recurrent IS in the same vascular territory at 90 days; the primary safety outcome was severe bleeding (symptomatic intracranial hemorrhage or major extracranial bleeding). Categorical variables were compared using χ 2 and continuous variables with the Student's t test; multivariable Cox regression adjusted for key covariates. Results: Of 2050 BIORISK-ICAS patients, 1658 met criteria (DAPT n=1499; SAPT+AC n=159). Mean age was 67 vs. 73 years, and 44% were women. At 90 days, recurrent IS occurred in 121 DAPT patients (8.07%) vs. 13 SAPT+AC patients (8.17%); unadjusted HR 0.83 (95% CI, 0.50–1.36; p=0.46). After adjustment for age, diabetes, coronary heart disease, atrial fibrillation, active smoking, and borderzone infarct, the adjusted HR was 0.99 (95% CI, 0.52–1.86; p=0.97). Severe bleeding occurred in 34 DAPT patients (2.26%) and 5 SAPT+AC patients (3.14%); unadjusted HR 0.79 (95% CI, 0.28–1.85; p=0.50), adjusted HR 0.66 (95% CI, 0.21–2.09; p=0.47). Conclusions: In patients with symptomatic ICAS, DAPT and SAPT+AC were associated with similar risks of 90-day recurrent ischemic stroke and severe bleeding. Well-powered randomized trials are needed to determine the optimal antithrombotic regimen in this high-risk population.
Dissecting Aneurysm in Cervical Artery Dissection: Insights From the STOP-CAD Study
Khan, Muhib, Keser, Z, Shu, Liqi , Lee, Elizabeth M., Ho, Melanie, Klein, Piers, Mallick, Dania, Griffin, Kim, Mandel, Daniel M, Leker, Ronen R., Metanis, Issa, Krishnaiah, Balaji , Omran, Setareh Salehi , Bakradze, Ekaterina, Henninger, Nils, Engelter, Stefan T, Antonenko, Kateryna, Marto, Joao Pedro, Rothstein, Aaron, Khazaal, Ossama , Nolte, Christian H., Crandall, Ross Curtiss, Lester, Evan, Nehme, Ahmad , Ghannam, Malik, AlMajali, Mohammad, Elnazeir, Marwa , Kasab, Sami Al, Asad, Syed Daniyal , Balabhadra, Anvesh , Fonseca, Ana Catarina , Cruz, Diana , Romoli, Michele, Sen, Shayak, Zedde, Marialuisa, Samaniego, Edgar A., Zubair, Adeel , Stretz, Christoph, Kam, Wayneho , AbdalKader, Mohamad, Yaghi, Shadi, Nguyen, Thanh N., Keser, Zafer , Klein, Piers , Henninger, Nils , Mandel, Daniel , Lee, Elizabeth , Nolte, Christian H. , Khan, Muhib , Keser, Zafer , Lee, Elizabeth , Klein, Piers , Griffin, Kim J. , Mandel, Daniel M , Leker, Ronen R , Metanis, Issa , Salehi Omran, Setareh , Bakradze, Ekaterina , Henninger, Nils , Engelter, Stefan T , Heldner, Mirjam R , Antonenko, Kateryna , Siegler, James E , Marto, João Pedro , Rothstein, Aaron , Khazaal, Ossama , Nolte, Christian H , Crandall, Ross , Nehme, Ahmad , Mac Grory, Brian , Ghannam, Malik , Almajali, Mohammad , Elnazeir, Marwa , Al Kasab, Sami , Asad, Syed Daniyal , Balabhadra, Anvesh , Fonseca, Ana Catarina , Cruz, Diana , Romoli, Michele , Saleh Velez, Faddi , Simpkins, Alexis N , Zedde, Marialuisa , Samaniego, Edgar A , Zubair, Adeel , Stretz, Christoph , Kam, Wayneho , Abdalkader, Mohamad , Yaghi, Shadi , Nguyen, Thanh N , Khan, Muhib , Ho, Melanie, Metanis, Issa , Shahripour, Reza Bavarsad , Bakradze, Ekaterina , Engelter, Stefan T. , Heldner, Mirjam R. , Siegler, James E. , Marto, João Pedro , Rothstein, Aaron , Crandall, Ross , Grory, Brian Mac , Ghannam, Malik , Kasab, Sami Al , Velez, Faddi G. Saleh , Simpkins, Alexis N. , Zedde, Marialuisa , Stretz, Christoph , Abdalkader, Mohamad , Yaghi, Shadi
Stroke | January 29, 2026 | Volume: 57 | Issue: 4 | Pages: 865-875
BACKGROUND: Cervical artery dissection (CeAD) may result in dissecting aneurysm (DA) formation. We aimed to characterize risk factors and clinical outcomes associated with DA in a large, international CeAD cohort. METHODS: We performed a secondary analysis of STOP-CAD (Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection), an international, multicenter, retrospective cohort. Patients with spontaneous CeAD were assessed for DA at baseline and de novo DA formation. Significant covariates in univariable analysis were included in multivariable regression models aiming to identify factors associated with DA formation. Logistic regression and Cox proportional hazards models evaluated the association of DA with ischemic and hemorrhagic outcomes. RESULTS: Among 4008 patients with CeAD, 546 (13.6%) had a DA at baseline, and 221/2938 (7.5%) patients developed a de novo DA during follow-up, of which 172/221 (78.2%) were detected in the first 180 days. Patients with DA had a mean age of 47 years, and 383 (49.9%) were women. Baseline or de novo DA was associated with a history of connective tissue disorder (adjusted odds ratio [aOR], 2.02 [95% CI, 1.22–3.36]), fibromuscular dysplasia (aOR, 1.69 [95% CI, 1.28–2.25]), and multiple vessel dissection (aOR, 1.53 [95% CI, 1.19–1.98]). Lower odds of DA were seen in Hispanic ethnicity (aOR, 0.64 [95% CI, 0.43–0.97]) and ischemic stroke presentation (aOR, 0.41 [95% CI, 0.34–0.49]). Fibromuscular dysplasia was associated with de novo DA formation (aOR, 2.30 [95% CI, 1.52–3.49]). DA was not associated with ischemic stroke (hazard ratio, 0.71 [95% CI, 0.44–1.16]; P =0.173) or intracranial hemorrhage (HR, 1.09 [95% CI, 0.42–2.84]; P =0.86) by day 180. CONCLUSIONS: DAs are relatively common manifestations of CeAD, typically occurring within 6 months of CeAD diagnosis. DA was not associated with an increased risk of subsequent ischemic stroke or intracranial hemorrhage.