Stroke Risk and Antithrombotic Treatment During Follow-up of Patients With Ischemic Stroke and Cortical Superficial Siderosis

and Microbleeds International Collaborative Network (MICON), Joan Martí-Fàbregas, Pol Camps-Renom, Jonathan G Best, Anna Ramos-Pachon, Marina Guasch-Jiménez, Alejandro Martinez-Domeño, Daniel Guisado-Alonso, Beatriz M Gómez-Ansón, Gareth Ambler, Duncan Wilson, Keon-Joo Lee, Jae-Sung Lim, Hee-Joon Bae, Masayuki Shiozawa, Masatoshi Koga, Kazunori Toyoda, Michael G Hennerici, Hugues Chabriat, Eric JouventDebbie Yuen Kwun Wong, Henry Mak, Kui Kai Lau, Young Dae Kim, Tae-Jin Song, Ji-Hoe Heo, Sebastian Eppinger, Thomas Gattringer, Ender Uysal, Derya Selçuk Demirelli, Natan Bornstein, Einor Ben Assayag, Hen Hallevi, Jeremy A Molad, Masashi Nishihara, Jun Tanaka, Hideo Hara, Yusuke Yakushiji, Shelagh B Coutts, Eric Smith, Alexandros A Polymeris, Benjamin Wagner, David Seiffge, Philippe A Lyrer, Nils Peters, Stefan T Engelter, Rustam Al-Shahi Salman, Hans Rudolf Jäger, Gregory Y H Lip, Martina Goeldlin, Leonidas Panos, Christopher Charles Karayiannis, Thanh G Phan, Velandai K Srikanth, Nicolas Christ, Sarah Gunkel, Felix Fluri, Thomas W Leung, Yannie O Y Soo, Winnie Chu, Jill Abrigo, Carmen Barbato, Simone Browning, Robert Simister, Anne-Marie Mendyk, Régis Bordet, Saima Hilal, Bibek Gyanwali, Christopher Chen, Simon Jung, Dilek Necioglu Orken, David Werring, Luis Prats-Sanchez

Research output: Contribution to journalArticlepeer-review


BACKGROUND AND OBJECTIVES: In patients with ischemic stroke (IS) or TIA and cortical superficial siderosis (cSS), there are few data regarding the risk of future cerebrovascular events and also about the benefits and safety of antithrombotic drugs for secondary prevention. We investigated the associations of cSS and stroke risk in patients with recent IS or TIA.

METHODS: We retrospectively analyzed the Microbleeds International Collaborative Network (MICON) database. We selected patients with IS or TIA from cohorts who had MRI-assessed cSS, available data on antithrombotic treatments, recurrent cerebrovascular events [Intracranial hemorrhage -ICrH-, IS, or any stroke (ICrH or IS)], and mortality. We calculated incidence rates (IR) and performed univariable and multivariable Cox regression analyses.

RESULTS: Of 12.669 patients (mean age 70.4±12.3 years, 57.3% men), cSS was detected in 273 (2.2%) patients. During a mean follow-up of 24±17 months, IS was more frequent than ICrH in both cSS (IR 57.1 versus 14.6 per 1000 patient-years) and non-cSS groups (33.7 versus 6.3 per 1000 patient years). Compared to the non-CSS group, cSS was associated with any stroke on multivariable analysis [IR 83 versus 42 per 1000 patient-years, adjusted HR for cSS 1.62 (95%CI: 1.14-2.28; p=0.006)]. This association was not significant in subgroups of patients treated with antiplatelet drugs (n=6.554) or with anticoagulants (n=4.044). Patients with cSS who were treated with both antiplatelet drugs and anticoagulants (n=1.569) had a higher incidence of ICrH (IR 107.5 vs 4.9 per 1000 patient-years, adjusted HR 13.26; 95%CI: 2.90-60.63; p=0.001) and of any stroke (IR 198.8 vs 34.7 per 1000 patient-years, adjusted HR 5.03; 95%CI: 2.03-12.44; p<0.001) compared to the non-CSS group.

DISCUSSION: Patients with IS or TIA with cSS are at increased risk of stroke (ICrH or IS) during follow-up; the risk of IS exceeds that of ICrH for patients receiving antiplatelet or anticoagulant treatment alone, but the risk of ICrH exceeds that of IS in patients receiving both treatments. The findings suggest that either antiplatelet or anticoagulant treatment alone should not be avoided in patients with cSS, but combined antithrombotic therapy might be hazardous. Our findings need to be confirmed by randomized clinical trials.

Original languageEnglish
Early online date19 Dec 2022
Publication statusE-pub ahead of print - 19 Dec 2022


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