A national survey at primary stroke centers about treatment strategies for patients with acute lacunar stroke

• Published in: Japanese Journal of Stroke Vol. 45; no. 4; pp. 310 - 316
• Main Authors: Ohara, Tomoyuki, Tanaka, Eijirou, Ashida, Shinji, Maezono-Kandori, Keiko, Ogura, Shiori, Menjo, Kanako, Mizuno, Toshiki
• Format: Journal Article
• Language: Japanese
• Published: The Japan Stroke Society 2023
• Subjects: acute treatment; antithrombotic therapy; argatroban; branch atheromatous disease; lacunar stroke
• ISSN: 0912-0726; 1883-1923
• DOI: 10.3995/jstroke.11120

Backgrounds and Purpose: Neurological worsening often occurs in patients with acute perforating artery infarction including branch atheromatous disease (BAD) against antithrombotic therapies, leading to poor functional outcomes. However, the effective antithrombotic therapy has not been established. The purpose of our study was to clarify acute treatment strategies for perforating artery infarction at primary stroke centers (PSCs) in Japan. Methods: We conducted a web survey at 500 PSCs. We provided clinical information and DWI images of different perforating artery infarction cases such as lacunar stroke and BAD and asked acute treatment strategies in each case. Results: The response rate from PSCs was 38%. In cases with NIHSS 3 and 6 hours after stroke onset, dual antiplatelet therapy (aspirin+clopidogrel) was selected only in about 10% as initial treatments in BAD cases, whereas a combination therapy of 2 or more antiplatelets plus anticoagulants (mainly argatroban) was selected in about 70% of BAD cases and in 25% of lacunar stroke cases. A further antithrombotic agent was added on neurological worsening in approximately half of PSCs, which selected 2 or more antiplatelets plus anticoagulants for BAD cases. In a BAD case with NIHSS 6 and 2 hours of stroke onset, intravenous tPA was selected in 87%. At early neurological worsening after thrombolysis, 35% of PSCs answered that they initiated antithrombotic agents within 24 hours after thrombolysis. Conclusion: At most of PSCs in Japan, more aggressive antithrombotic therapies beyond current stroke treatment guideline may be conducted, especially for BAD.