Background and Aims

Background: Covert brain infarcts (CBIs) detected by MRI are more frequent than recurrent ischemic strokes in secondary stroke prevention trials. The effect of the oral factor XIa inhibitor asundexian when added to antiplatelet therapy on incident CBIs among patients with acute non-cardioembolic ischemic stroke was assessed in the PACIFIC-Stroke trial.

Purpose: To report the effects of asundexian, an oral anticoagulant given once daily that directly inhibits factor XIa, on different locations/sizes/multiplicity of incident CBIs.

Methods

Methods: PACIFIC-Stroke (NCT04304508) was an international, double-blind, placebo-controlled, phase II randomized trial involving 1808 participants comparing three dosages of asundexian (BAY 2433334) with placebo. Participants were randomized within 48 hours of the qualifying ischemic stroke, and all received foundation antiplatelet therapy. Participants underwent a study MRI that included required sequences at entry and after 6 months or earlier if study drug was discontinued, with images transferred to a central MRI repository for independent interpretation by two radiologists. Incident CBIs were counted in participants without recurrent ischemic stroke to avoid counting new lesions related to symptomatic infarcts.

Results

Results: The main trial results will be presented at the European Society of Cardiology Conference on August 28^th and will be briefly reviewed. New information will be presented about the 1428 (79%) participants with both baseline and follow-up MRIs adequate to assess incident CBIs, including treatment effects according to size, location, and multiplicity of incident CBIs.

Conclusions

Conclusions: Asundexian effects for prevention of different subtypes of CBIs has implications for secondary stroke prevention and is important for design of future trials.

Background and Aims

The effect of surgical treatment for spontaneous intracerebral hemorrhage (ICH) remains uncertain. We conducted an observational retrospective cohort study on supra-centimeter spontaneous ICH treated with neurosurgical or conservative management. The baseline demographics and risk factors were correlated with in-hospital mortality and 3 and 6-month survival rates stratified by management.

Methods

We included all patients with evidence of spontaneous ICH > 1 cm on CT between August 2020- March 2021 and admitted to the “SMM” Hospital in Perugia.

Results

Onehundredtwentytwo patients were included in the study, and 45% (n.55) were surgically treated. The mean age was 71,9±15.3, and 61% (n.75) were males. Intra-hospital mortality resulted being 31% (n.38), 3 months-survival was 63% (n.77) and 6 months-survival was 60% (n.73).

From the multivariate analysis of the surgical patients versus medical patient, we observed the surgical patients were younger (67,5±14,9 vs 75,5 ±14,7 y; OR 0.87; CI 95% 0,85-0,94; p 0,001), with greater ICH volume at the onset (61±39,4 cc vs 51± 64 cc; OR 1,03; CI 95% 1,005-1,07; p 0,05), more midline shift (7,61 ±5,54 mm vs 4,09 ±5,88 mm; OR 1,37; CI 95% 1,045-1,79; p 0,023), and a higher ICH score (3 vs 2 mean ICH score; OR 21,12; CI 95% 2,6-170,6; p 0,004). Intra-hospital mortality was respectively 33% vs 30%, 3 month-survival was 64% vs 63% and 6 month- survival were 60% in both groups.

Conclusions

Our patient cohort shows no overall benefit from surgery over conservative treatment, but surgical patients were younger and had larger ICH volume.