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Abstract
Objective: We aimed to investigate whether the efficacy and safety of clopidogrel plus aspirin vs aspirin alone were consistent between patients with and without intracranial arterial stenosis (ICAS), in the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial.
Methods: We assessed the interaction of the treatment effects of the 2 antiplatelet therapies among patients with and without ICAS, identified by magnetic resonance angiography (MRA) in CHANCE (ClinicalTrials.gov identifier NCT00979589).
Results: Overall, 1,089 patients with MRA images available in CHANCE were included in this subanalysis, 608 patients (55.8%) with ICAS and 481 (44.2%) without. Patients with ICAS had higher rates of recurrent stroke (12.5% vs 5.4%; p < 0.0001) at 90 days than those without. But there was no statistically significant treatment by presence of ICAS interaction on either the primary outcome of any stroke (hazard ratio for clopidogrel plus aspirin vs aspirin alone: 0.79 [0.47–1.32] vs 1.12 [0.56–2.25]; interaction p = 0.522) or the safety outcome of any bleeding event (interaction p = 0.277).
Conclusions: The results indicated higher rate of recurrent stroke in minor stroke or high-risk TIA patients with ICAS than in those without. However, there was no significant difference in the response to the 2 antiplatelet therapies between patients with and without ICAS in the CHANCE trial.
Classification of evidence: This study provides Class II evidence that for patients with acute minor stroke or TIA with and without ICAS identified by MRA, clopidogrel plus aspirin is not significantly different than aspirin alone in preventing recurrent stroke.
GLOSSARY
- CHANCE=
- Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events;
- CHARISMA=
- Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance;
- CI=
- confidence interval;
- GUSTO=
- Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries;
- HR=
- hazard ratio;
- ICAS=
- intracranial arterial stenosis;
- MRA=
- magnetic resonance angiography;
- POINT=
- Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke;
- SPS3=
- Secondary Prevention of Small Subcortical Strokes
Footnotes
↵* These authors contributed equally to this work.
CHANCE coinvestigators are listed on the Neurology® Web site at Neurology.org.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received February 3, 2015.
- Accepted in final form June 3, 2015.
- © 2015 American Academy of Neurology
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