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Frequency and Patterns of Brain Infarction in Patients With Embolic Stroke of Undetermined Source: NAVIGATE ESUS Trial.
Sharma, Mukul; Smith, Eric E; Pearce, Lesly A; Shoamanesh, Ashkan; Perera, Kanjana S; Coutts, Shelagh B; Damgaard, Dorte; Ameriso, Sebastian F; Rha, Joung-Ho; Modrau, Boris; Yoon, Byung-Woo; Romano, Marina; Messé, Steven R; Barlinn, Jessica; Lambeck, Johann; Saad, Feryal; Berkowitz, Scott D; Mundl, Hardi; Connolly, Stuart J; Hart, Robert G.
Afiliação
  • Sharma M; Department of Medicine (Neurology), McMaster University/Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada (M.S, A.S., K.S.P.).
  • Smith EE; Department of Clinical Neurosciences, University of Calgary, Alberta, Canada (E.E.S.).
  • Pearce LA; Biostatistics Consultant, St. Catharines, Ontario, Canada (L.A.P.), University of Calgary, Alberta, Canada.
  • Shoamanesh A; Department of Medicine (Neurology), McMaster University/Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada (M.S, A.S., K.S.P.).
  • Perera KS; Department of Medicine (Neurology), McMaster University/Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada (M.S, A.S., K.S.P.).
  • Coutts SB; Department of Clinical Neurosciences, Radiology, and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada.
  • Damgaard D; Department of Neurology, Aarhus University Hospital, Denmark (D.D.).
  • Ameriso SF; Institute for Neurological Research-FLENI, Buenos Aires, Argentina (S.F.A.).
  • Rha JH; Inha University Hospital, Incheon, Korea (J.-H.R.).
  • Modrau B; Department of Neurology, Aalborg University Hospital, Denmark (B.M.).
  • Yoon BW; Department of Neurology, Seoul National University Hospital, Korea (B.-W.Y.).
  • Romano M; Department of Neurology, Centro Estudios Medicos e Invest. Clinicas "Dr. N. Quirno", Buenos Aires, Argentina (M.R.).
  • Messé SR; Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.).
  • Barlinn J; Department of Neurology, University Hospital Carl Gustav Carus, Technische Universitat Dresden, Germany (J.B.).
  • Lambeck J; Department of Neurology and Clinical Neurophysiology, Universitätsklinikum Freiburg, Germany (J.L.).
  • Saad F; Department of Clinical Neurosciences (F.S.), University of Calgary, Alberta, Canada.
  • Mundl H; Bayer AG, Wuppertal, Germany (H.M.).
  • Connolly SJ; Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (R.G.H., S.J.C.).
  • Hart RG; Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (R.G.H., S.J.C.).
Stroke ; 53(1): 45-52, 2022 01.
Article em En | MEDLINE | ID: mdl-34538089
ABSTRACT
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. Registration URL https//www.clinicaltrials.gov; Unique identifier NCT02313909.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Infarto Encefálico / Embolia Intracraniana / Inibidores do Fator Xa / Rivaroxabana Tipo de estudo: Clinical_trials / Etiology_studies / Guideline / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Infarto Encefálico / Embolia Intracraniana / Inibidores do Fator Xa / Rivaroxabana Tipo de estudo: Clinical_trials / Etiology_studies / Guideline / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2022 Tipo de documento: Article