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Carotid Stenosis and Recurrent Ischemic Stroke: A Post-Hoc Analysis of the POINT Trial.

Publication ,  Journal Article
Yaghi, S; de Havenon, A; Rostanski, S; Kvernland, A; Mac Grory, B; Furie, KL; Kim, AS; Easton, JD; Johnston, SC; Henninger, N
Published in: Stroke
July 2021

BACKGROUND AND PURPOSE: Randomized trials demonstrated the benefit of dual antiplatelet therapy in patients with minor ischemic stroke or high-risk transient ischemic attack. We sought to determine whether the presence of carotid stenosis was associated with increased risk of ischemic stroke and whether the addition of clopidogrel to aspirin was associated with more benefit in patients with versus without carotid stenosis. METHODS: This is a post-hoc analysis of the POINT trial (Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke) that randomized patients with minor ischemic stroke or high-risk transient ischemic attack within 12 hours from last known normal to receive either clopidogrel plus aspirin or aspirin alone. The primary predictor was the presence of ≥50% stenosis in either cervical internal carotid artery. The primary outcome was ischemic stroke. We built Cox regression models to determine the association between carotid stenosis and ischemic stroke and whether the effect of clopidogrel was modified by ≥50% carotid stenosis. RESULTS: Among 4881 patients enrolled POINT, 3941 patients met the inclusion criteria. In adjusted models, ≥50% carotid stenosis was associated with ischemic stroke risk (hazard ratio, 2.45 [95% CI, 1.68-3.57], P<0.001). The effect of clopidogrel (versus placebo) on ischemic stroke risk was not significantly different in patients with <50% carotid stenosis (adjusted hazard ratio, 0.68 [95% CI, 0.50-0.93], P=0.014) versus those with ≥50% carotid stenosis (adjusted hazard ratio, 0.88 [95% CI, 0.45-1.72], P=0.703), P value for interaction=0.573. CONCLUSIONS: The presence of carotid stenosis was associated with increased risk of ischemic stroke during follow-up. The effect of added clopidogrel was not significantly different in patients with versus without carotid stenosis. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03354429.

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Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

July 2021

Volume

52

Issue

7

Start / End Page

2414 / 2417

Location

United States

Related Subject Headings

  • Stroke
  • Retrospective Studies
  • Recurrence
  • Platelet Aggregation Inhibitors
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Humans
  • Follow-Up Studies
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
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Yaghi, S., de Havenon, A., Rostanski, S., Kvernland, A., Mac Grory, B., Furie, K. L., … Henninger, N. (2021). Carotid Stenosis and Recurrent Ischemic Stroke: A Post-Hoc Analysis of the POINT Trial. Stroke, 52(7), 2414–2417. https://doi.org/10.1161/STROKEAHA.121.034089
Yaghi, Shadi, Adam de Havenon, Sara Rostanski, Alexandra Kvernland, Brian Mac Grory, Karen L. Furie, Anthony S. Kim, J Donald Easton, S Claiborne Johnston, and Nils Henninger. “Carotid Stenosis and Recurrent Ischemic Stroke: A Post-Hoc Analysis of the POINT Trial.Stroke 52, no. 7 (July 2021): 2414–17. https://doi.org/10.1161/STROKEAHA.121.034089.
Yaghi S, de Havenon A, Rostanski S, Kvernland A, Mac Grory B, Furie KL, et al. Carotid Stenosis and Recurrent Ischemic Stroke: A Post-Hoc Analysis of the POINT Trial. Stroke. 2021 Jul;52(7):2414–7.
Yaghi, Shadi, et al. “Carotid Stenosis and Recurrent Ischemic Stroke: A Post-Hoc Analysis of the POINT Trial.Stroke, vol. 52, no. 7, July 2021, pp. 2414–17. Pubmed, doi:10.1161/STROKEAHA.121.034089.
Yaghi S, de Havenon A, Rostanski S, Kvernland A, Mac Grory B, Furie KL, Kim AS, Easton JD, Johnston SC, Henninger N. Carotid Stenosis and Recurrent Ischemic Stroke: A Post-Hoc Analysis of the POINT Trial. Stroke. 2021 Jul;52(7):2414–2417.

Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

July 2021

Volume

52

Issue

7

Start / End Page

2414 / 2417

Location

United States

Related Subject Headings

  • Stroke
  • Retrospective Studies
  • Recurrence
  • Platelet Aggregation Inhibitors
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Humans
  • Follow-Up Studies
  • Female