TY -的T1 Genotype-Guided双重抗血小板治疗轻微中风或短暂性脑缺血发作与单个小皮层下梗死JF -神经学乔-神经病学SP - e1643 LP - e1654做- 10.1212 / WNL。首页0000000000206775六世- 100 - 16盟慧慧刘盟-晶晶盟安信孟夏王盟-徐秦盟盟李子晓-郝李盟Zixiao李盟——Yongjun王Y1 - 2023/04/18 UR - //www.ez-admanager.com/content/100/16/e1643.abstract N2 -背景和目标单一小皮层下梗死(拟建)是一种重要的中风亚型。首页最优抗血小板药物治疗缺血性中风患者一个拟建尚不清楚。我们旨在测试ticagrelor-aspirin预防卒中复发的疗效和安全性在拟建Ticagrelor或患者氯吡格雷与阿司匹林在高危患者急性Nondisabling脑血管事件二世(机会)试验。方法试验的机会,一个小中风或TIA患者进行CYP2C19功能丧失(LOF)等位基因被随机分配在24小时内出现症状后,要么ticagrelor-aspirin(安慰剂氯吡格雷+加载180毫克剂量的ticagrelor 1天,紧随其后的是90毫克每日两次天2 - 90)或clopidogrel-aspirin(安慰剂ticagrelor +加载300毫克剂量的氯吡格雷1天,紧随其后的是75毫克每天天2 - 90)。阿司匹林是应用在前21天。患者一个拟建(diffusion-weighted成像病变≤20毫米直径)包含在这一分析,进一步分为两种类型根据他们是否负责任的颅内动脉狭窄(英格尔):拟建+英格尔和拟建−英格尔。主要功效的结果是一个新的行程在90天。结果在2143名符合条件的患者,有负责任的英格尔,340和1803没有。Ticagrelor-aspirin减少中风复发患者在所有拟建(危险比[HR]: 0.55; 95% CI 0.38–0.78; p = 0.001) compared with clopidogrel-aspirin. Stroke recurrence occurred in 35/901 (3.9%) patients with SSSI − ICAS on ticagrelor-aspirin and in 72/902 (8.0%) on clopidogrel-aspirin (hazard ratio [HR]: 0.45; 95% CI 0.29–0.68; p < 0.001). In patients with SSSI + ICAS, the corresponding event rates were 14/176 (8.0%) and 13/164 (7.9%), respectively (HR: 1.20; 95% CI 0.45–3.23; p = 0.71; p for interaction = 0.08). The risk of severe or moderate bleeding only occurred in patients with SSSI − ICAS (5/901 [0.6%] vs 5/902 [0.6%]).Discussion In this prespecified substudy, ticagrelor-aspirin was superior to clopidogrel-aspirin in reducing the risk of stroke at 90 days among patients with SSSI who carried CYP2C19 LOF allele(s). Although there was no treatment-by-heterogeneous etiology interaction, a greater absolute risk reduction of stroke was observed in patients with SSSI − ICAS than in those with SSSI + ICAS.Classification of Evidence This study provides Class II evidence that ticagrelor and aspirin reduced the risk of stroke recurrence compared with clopidogrel with aspirin in adult patients with acute minor SSSI.BMI=body mass index; CHANCE-2=Ticagrelor or Clopidogrel with Aspirin in High-Risk Patients with Acute Nondisabling Cerebrovascular Events II; CTA=computed tomographic angiography; DWI=diffusion-weighted imaging; HR=hazard ratio; HR-MRI=high-resolution MRI; ICAS=intracranial artery stenosis; IQR=interquartile range; LOF=loss of function; MRA=magnetic resonance angiography; NIHSS=National Institutes of Health Stroke Scale; PAD=parental artery disease; SAD=small artery disease; SPS3=Secondary Prevention of Small Subcortical Strokes; SSSI − ICAS=SSSI without responsible ICAS; SSSI + ICAS=SSSI with responsible ICAS; SSSI=single small subcortical infarction; TOF=time of flight ER -