RT Journal Article SR Electronic T1 Lp-PLA2 and dual antiplatelet agents in intracranial arterial stenosis JF Neurology JO Neurology FD Lippincott Williams & Wilkins SP e181 OP e189 DO 10.1212/WNL.0000000000008733 VO 94 IS 2 A1 Ming Yang A1 Anxin Wang A1 Jiejie Li A1 Xingquan Zhao A1 Liping Liu A1 Xia Meng A1 Jing Jing A1 Nan Zhang A1 S. Claiborne Johnston A1 Yilong Wang A1 Yongjun Wang YR 2020 UL http://n.neurology.org/content/94/2/e181.abstract AB Objective To evaluate the interaction effect of lipoprotein-associated phospholipase A2 (Lp-PLA2) activity on the efficacy and safety of dual/single antiplatelet therapy in patients with and without intracranial arterial stenosis (ICAS) by the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events trial.Methods Patients with both MRI analysis and Lp-PLA2 testing results were included in the current subanalysis. The interaction of Lp-PLA2 activity with the effects of dual and single antiplatelet therapy were analyzed through Cox proportional hazards regressions model.Results Among the 797 patients, the mean age was 63.1 ± 10.8 years, 518 (65%) were men, 356 (44.7%) had ICAS, and 441 (55.3%) did not. There were significantly more patients with elevated Lp-PLA2 activity in the ICAS group than in the non-ICAS group (43.8% vs 35.4%, p = 0.02). There was significant interaction between Lp-PLA2 activity levels and the 2 antiplatelet therapies for prevention of stroke recurrences and combined vascular events even after adjustment for confounding factors exclusively for patients with ICAS (p = 0.017, 0.017, respectively), but not for those without (p = 0.332, 0.674, respectively). Compared with aspirin alone, dual antiplatelet therapy significantly reduced the risk of stroke recurrences and combined vascular events (adjusted hazard ratio 0.33 [0.12–0.89], p = 0.028; 0.33 [0.12–0.89], p = 0.028, respectively) for patients with ICAS and nonelevated Lp-PLA2 activity.Conclusions Presence of both ICAS and nonelevated Lp-PLA2 activity may predict better response to dual antiplatelet therapy in prevention of recurrent strokes and combined vascular events for patients with minor stroke or high-risk TIA.Clinicaltrials.gov identifier NCT00979589.CHANCE=Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events; CI=confidence interval; HR=hazard ratio; hs-CRP=high-sensitivity C-reactive protein; ICAS=intracerebral artery stenosis; LDL-C=low-density lipoprotein cholesterol; Lp-PLA2=lipoprotein-associated phospholipase A2; TOF-MRA=time-of-flight magnetic resonance angiography