Branch atheromatous disease (BAD) has been reported to contribute to small-vessel occlusion and is associated with a higher possibility of early neurological deterioration (END). Because the pathology of BAD is due to atherosclerosis, the investigators postulate that early intensive medical treatment with dual antiplatelet therapy(DAPT) and high-intensity statin may prevent END and recurrent stroke. The investigators hypothesise that intensive medical therapy can prevent END in BAD using aspirin, clopidogrel and high-intensity statin.
The SATBRAD study is a single-centre, prospective, open-label, single-group trial with a historical control group of BAD patients treated with single antiplatelet therapy and regular statin treatment in Chang Gung Memorial Hospital in Taiwan. Eligible participants are as follows: 1. have a clinical diagnosis of ischemic stroke; 2. National Institute of Health Stroke Scale (NIHSS) score of 1-8; 3. an ischemic lesion on diffuse-weighted imaging located in the middle cerebral artery(MCA) perforator, Heubner's artery or vertebrobasilar perforator territories; 4. BAD, defined by a visible lesion in three or more axial MRI cuts in the MCA perforator territory or Heubner's artery territories or infarcts that extended from the basal surface of the brainstem. 5. can receive intensive medical treatment within 24 hours of stroke onset. Participants in the intervention group will receive DAPT and high-intensity statin treatment. DAPT treatment is administered within 24 hours of stroke onset, with aspirin (300 mg loading and 100 mg/day) and clopidogrel (300mg and 75m/day). Participants will take aspirin and clopidogrel for 21 days and then keep aspirin or clopidogrel alone. High-intensity statin is administered, including atorvastatin 40-80mg or rosuvastatin 20 mg for 3 months. A historical control group of patients receiving single oral antiplatelet medication and regular statin treatment will be drawn from previous prospective observation studies which were executed since Jan. 2011 to Dec. 2020. The total sample sizes are 147 for intervention group and 277 for control group. The primary endpoint is the composite of END, defined as an increase of ≧2 points of NIHSS within 7 days, and recurrent ischemic stroke within 30 days.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
376
300mg loading and 75mg/day from day 2
Aspirin(100-300mg/day)
Atorvastatin 40-80mg/day
Rosuvastatin 20 mg/day.
Yenchu Huang
Chiayi City, Taiwan
The percentage of patients with early neurological deterioration within 7 days and recurrent ischemic stroke within 30 days.
The early neurological deterioration is defined as an increase of 2 points of NIHSS. The NIHSS is composed of 11 items, each of which scores a specific ability between a 0 and 4. For each item, a score of 0 typically indicates normal function in that specific ability, while a higher score is indicative of some level of impairment. The maximum possible score is 42, with the minimum score being a 0.
Time frame: 30 days
Percentage of patients with favorable functional recovery defined as a mRS ≦1
Defined as a mRS ≦1. The Modified Rankin Scale (mRS) runs from 0-6, running from perfect health without symptoms(score 0) to death(score 6).
Time frame: 90 days
Percentage of patients with new clinical vascular events
ischemic stroke/hemorrhagic stroke/TIA/myocardial infarction/vascular death
Time frame: 90 days
Changes of atherosclerotic plaque
The changes of atherosclerotic plaque was measured by high-resolution MRI initially and 6 months later.
Time frame: 6 months
Numbers of moderate to severe bleeding events
Time frame: 90 days
Total mortality
Time frame: 90 days
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