PT  - JOURNAL ARTICLE
AU  - Xie, Xuewei
AU  - Jing, Jing
AU  - Wang, Anxin
AU  - Xu, Qin
AU  - Zhao, Xingquan
AU  - Lin, Jinxi
AU  - Chen, Pan
AU  - Jiang, Yong
AU  - Wang, Yilong
AU  - Li, Hao
AU  - Meng, Xia
AU  - Wang, Yongjun
TI  - Dual antiplatelet therapy with ticagrelor vs clopidogrel in patients with TIA or minor stroke with or without symptomatic carotid artery stenosis: a post hoc analysis of the CHANCE-2 trial
AID  - 10.1136/svn-2024-003293
DP  - 2025 Jan 07
TA  - Stroke and Vascular Neurology
PG  - svn-2024-003293
4099  - http://svn.bmj.com/content/early/2025/01/07/svn-2024-003293.short
4100  - http://svn.bmj.com/content/early/2025/01/07/svn-2024-003293.full
AB  - Background and purpose Symptomatic internal carotid artery stenosis (sCAS) is an essential cause of transient ischaemic attack (TIA) or minor stroke. We aimed to evaluate whether the superiority of aspirin-ticagrelor over aspirin-clopidogrel varies between patients with sCAS or not.Methods This was a post-hoc analysis of the High-Risk Patients with Acute Nondisabling Cerebrovascular Events-II (CHANCE-2) trial, all of which were CYP2C19 loss-of-function alleles carriers. The primary exposures of interest were the treatment group and sCAS status. The primary efficacy endpoint was the new stroke assessed within 90 days.Results A total of 5920 (92.3%) from 6412 were analysed, including 197 (3.3%) with sCAS and 5723 (96.7%) without sCAS. Stroke recurrence occurred in 13 (12.15%) and 11 (12.22%) patients with sCAS who received aspirin-ticagrelor and aspirin-clopidogrel, respectively (adjusted HR, 1.04; 95% CI, 0.46 to 2.36; p=0.930). Among patients without sCAS, there were 158 cases (5.52%) of new strokes in the aspirin-ticagrelor group and 222 cases (7.76%) in the aspirin-clopidogrel group (HR, 0.70; 95% CI, 0.57 to 0.86; p=0.0006). The treatment-by-sCAS subtype was not significant (p=0.405).Conclusions Genotype-guided dual antiplatelet treatment with aspirin-ticagrelor may be beneficial for preventing recurrent strokes in patients without sCAS; however, it appears less effective in those with sCAS. No significant interaction was found between the treatment and sCAS subtypes.Trial registration number NCT04078737.Data are available upon reasonable request. Requests for access to the data reported in this paper will be considered by the corresponding author.