Treatment Challenge of Complex Aortic Atherosclerosis in Acute Ischemic Stroke Context: A Retrospective Study
DOI:
https://doi.org/10.24950/rspmi.2426Keywords:
Aorta, Thoracic, Atherosclerosis, Heart Disease Risk Factors, Ischemia, StrokeAbstract
Introduction: Complex aortic atherosclerosis is an important cause of stroke. However, the lack of scientific evidence makes its treatment controversial, which highlights the need for further research. This study aims to evaluate the efficacy and safety of the therapeutic strategies used in complex aortic atherosclerosis.
Material and Methods: A retrospective analysis was carried out on patients hospitalized with ischemic stroke and complex aortic atherosclerosis diagnosed by transesophageal echocardiography, between January 1, 2010 and December 31, 2022.
Results: Of the 82 patients included, 23.2% had ischemic stroke recurrence, of which 47.4% were treated with clopidogrel monotherapy. Patients taking clopidogrel had a higher ischemic stroke recurrence rate (p <0.001), while patients taking dual antiplatelet therapy had a lower recurrence rate (p = 0.035). There was no recurrence in patients receiving direct oral anticoagulants. Regarding the patients treated with warfarin, five had recurrence with an infra-therapeutic INR and two had hemorrhagic events.
Conclusion: In our population, dual antiplatelet therapy
with acetylsalicylic acid and clopidogrel for 3 to 6 months
followed by single antiplatelet therapy with acetylsalicylic acid seems to be the safest and most effective strategy for the treatment of ischemic stroke associated with complex aortic atherosclerosis, while clopidogrel monotherapy was associated with a higher recurrence rate. Direct oral anticoagulants appeared to be effective and safer than warfarin for patients receiving anticoagulant therapy.
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