title: Clopidogrel plus Aspirin for Symptomatic Intracranial Atherosclerotic Stenosis: A Pilot Study.
abstract: OBJECTIVE
  There are limited data on the optimal duration of dual antiplatelet therapy for secondary stroke prevention in patients with symptomatic intracranial atherosclerotic disease.
  
  
  METHODS
  Consecutive patients presenting with high-grade (70-99%) symptomatic intracranial stenosis from January 1, 2011, to December 31, 2013, and evaluated within 30 days of the index event were eligible for this analysis. All patients underwent treatment with aspirin plus clopidogrel for a target duration of 12 months along with aggressive medical management based on the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) protocol; all patients were given gastrointestinal prophylaxis for the duration of their aspirin and clopidogrel treatment. Clinical and safety outcomes of our cohort were compared with the medical arm of the SAMMPRIS trial cohort (n = 227).
  
  
  RESULTS
  Our cohort included 25 patients that met the inclusion criteria. Achievement of blood pressure and LDL cholesterol targets were similar between our cohort and the SAMMPRIS cohort. At 1 year, the rates of stroke, myocardial infarction or vascular death were 0% in our cohort and 16% in the SAMMPRIS cohort (p = 0.03). At 1 year, major bleeding rates were similar between our cohort and the SAMMPRIS cohort (4 vs. 2.2%, p = 1.0).
  
  
  CONCLUSIONS
  A prolonged course of dual antiplatelet therapy for symptomatic intracranial atherosclerotic disease may be associated with less vascular events with no increase in hemorrhagic complications.
authors: Department of Neurology, Emory University School of Medicine, Atlanta, Ga, USA; Department of Neurosciences, Rochester Regional Health, Rochester, N.Y, USA.
authors: Tareq
authors: T
authors: Kass-Hout
authors: Department of Neurology, Emory University School of Medicine, Atlanta, Ga, USA.
authors: Melanie
authors: M
authors: Winningham
authors: Department of Neurology, Emory University School of Medicine, Atlanta, Ga, USA; Department of Neurosciences, Catholic Health System, Buffalo, N.Y., USA.
authors: Omar
authors: O
authors: Kass-Hout
authors: Department of Neurology, Emory University School of Medicine, Atlanta, Ga, USA.
authors: Laura
authors: L
authors: Henriquez
authors: Department of Neurology, Emory University School of Medicine, Atlanta, Ga, USA.
authors: Frank
authors: F
authors: Tong
authors: Department of Neurology, Emory University School of Medicine, Atlanta, Ga, USA.
authors: Jacques
authors: J
authors: Dion
authors: Department of Neurology, Emory University School of Medicine, Atlanta, Ga, USA.
authors: Michael
authors: M
authors: Cawley
authors: Department of Neurology, Emory University School of Medicine, Atlanta, Ga, USA.
authors: Samir
authors: S
authors: Belagaje
authors: Department of Neurology, Emory University School of Medicine, Atlanta, Ga, USA.
authors: Michael
authors: M
authors: Frankel
authors: Department of Neurology, Emory University School of Medicine, Atlanta, Ga, USA.
authors: Aaron
authors: A
authors: Anderson
authors: Department of Neurology, Emory University School of Medicine, Atlanta, Ga, USA.
authors: Fadi
authors: F
authors: Nahab
keywords: Acute ischemic stroke; Dual antiplatelet therapy; Intracranial atherosclerotic disease; Transient ischemic attack