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Fifty-two patients had symptomatic intracranial atherosclerosis and fulfilled entry criteria. Twenty-nine of the 52 patients (55.8%) had cerebral ischemic events while receiving an antithrombotic agent (antiplatelet agents [55%], warfarin [31%], or heparin [14%]). In a Cox regression model, older age was an independent predictor of failure of antithrombotic therapy, and warfarin use was associated with a decrease in risk. Recurrent TIA (n = 7), nonfatal/fatal stroke (n = 6/1), or death (n= 1) occurred in 15 of 29 (51.7%) of the patients who failed antithrombotic therapy. The median time to recurrent TIA, stroke, or death was 36 days (95% CI 13 to 59). Patients with symptomatic intracranial atherosclerosis who fail antithrombotic therapy have extremely high rates of recurrent TIA/stroke or death. Recurrent ischemic events typically occur within a few months after failure of standard medical therapy. The high recurrence risk observed warrants testing of alternative treatment strategiessuch as intracranial angioplasty. |
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aspirin,failure of
atheromatous branch disease,intracranial
basilar artery stenosis
carotid artery stenosis,intracranial
carotid siphon
carotid-siphon stenosis
cerebral atherosclerosis
cerebrovascular accident
cerebrovascular accident,recurrent
coumarin,failure of
heparin,failure of
middle cerebral artery,stenosis of
mortality
platelet inhibiting drugs
prognosis
transient ischemic attack
transluminal angioplasty,intracranial
transluminal angioplasty,intracranial-indications for
treatment of neurologic disorder
vertebral artery disease
vertebral artery stenosis
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