Aspirin Or Anticoagulants In Stenosis Of The Middle Cerebral Artery: A Randomized Trial

Background: We report the results of an open, randomized, multicenter trial that compared the efficacy of aspirin to oral anticoagulants ( OA) for the prevention of vascular events in patients with symptomatic stenosis of the middle cerebral artery ( MCA). Methods: Participants were randomly assigned to receive 300 mg/ day of aspirin or a dose of OA ( target INR 2 - 3). The MCA stenosis was demonstrated by conventional angiography or by at least two noninvasive examinations. Patients had either transient ischemic attack or cerebral infarct ( CI) attributable to the MCA stenosis within 90 days before inclusion. The primary endpoint was: nonfatal CI, nonfatal acute myocardial infarct, vascular death and major hemorrhage. The patients were followed-up for a minimum of 1 year and a maximum of 3 years. Results: The study included 28 patients ( 14 in each treatment group); the average age was 67 +/- 9.9 years. Men constituted 68% of the patients. After a mean follow- up of 23.1 +/- 10.9 months, there were no recurrences of CI in both groups. No endpoint was reported in the aspirin group, but 2 patients in the OA group ( 14.3%) exhibited vascular events: 1 acute myocardial infarct and 1 intracerebral hemorrhage). However, this difference was not statistically significant ( p = 0.48). Conclusions: Our study suggests that aspirin is the treatment of choice for the prevention of vascular events in patients with symptomatic MCA stenosis. Copyright (c) 2006 S. Karger AG, Basel