Branch atheromatous disease diagnosed as embolic stroke of undetermined source: A sub-analysis of NAVIGATE ESUS

作者：Shinichiro Uchiyama, Ḱazunori Toyoda, Kazuo Kitagawa, Yasushi Okada, Sebastian Francisco Ameriso, Hardi Mundl, Scott D. Berkowitz, Takashi Yamada, Yan Yun Liu, Robert G. Hart, on behalf of the NAVIGATE ESUS Investigators · 发表于：International Journal of Stroke · 年份：2019 · DOI：10.1177/1747493019852177 · 被引用次数：30 · 研究领域：Aortic Thrombus and Embolism、Cerebrovascular and Carotid Artery Diseases、Peripheral Artery Disease Management

Background Branch atheromatous disease (BAD) is distinctive from large and small arterial diseases, which is single subcortical infarction larger than lacunar stroke in the territories of deep perforators without relevant arterial stenosis. BAD meets the current criteria of embolic stroke of undetermined source. We performed an exploratory analysis of BAD in patients recruited to NAVIGATE embolic stroke of undetermined source, a randomized controlled trial to compare rivaroxaban and aspirin in embolic stroke of undetermined source patients. Methods and results Among 3972 stroke patients in cerebral hemispheres with intracranial arterial imaging, 502 (12.6%) patients met the criteria for BAD. BAD was associated with younger age (years; OR: 0.97, 95% CI: 0.96–0.98), race (Asian; OR: 1.78, 95% CI: 1.44–2.21), region (Eastern Europe; OR: 2.49, 95% CI: 1.87–3.32), and higher National Institute of Health Stroke Scale (OR: 1.17, 95% CI: 1.12–1.22) at randomization. During follow-up, stroke or systemic embolism (2.5%/year vs. 6.2%/year, p = 0.0022), stroke (2.1%/year vs. 6.2%/year, p = 0.0008), and ischemic stroke (2.1%/year vs. 5.9%/year, p = 0.0013) occurred less frequently in BAD than non-BAD patients. There were no differences in annual rates of stroke or systemic embolism (2.5%/year vs. 2.5%/year, HR: 1.01, 95% CI: 0.33–3.14) or major bleeding (1.3%/year vs. 0.8%/year, HR: 1.51, 95% CI: 0.25–9.05) between rivaroxaban and aspirin groups among BAD patients. Conclusions BAD was rel...