22. European Stroke Conference 259 Etiology of stroke and risk factors The Carotid Plaque Imaging in Acute Stroke (CAPIAS) study: initial baseline data A. Bayer-Karpinska1, F. Schwarz2, H. Poppert3, J. Grimm4, C.C. Cyran5, T. Boeckh-Behrens6, K. Nikolaou7, Ch. Opherk8, T. Saam9, M Dichgans10 Institute for Stroke and Dementia Research, Munich, GERMANY1, Institute for clinical radiol-ogy, Munich, GERMANY2, Klinikum Rechts der Isar, Munich, GERMANY3, Institute for clinical radiology, Munich, GERMANY4, Institute for clinical radiology, Munich, GERMANY5, Klinikum Rechts der Isar, Munich, GERMANY6, Institute for clinical radiology, Munich, GERMANY7, Insti-tute for Stroke and Dementia Research, Munich, GERMANY8, Institute for clinical radiology, Mu-nich, GERMANY9, Institute for Stroke and Dementia Research10 Rationale: In up to 40% of ischemic stroke patients, no definite cause can be established. Histo-pathological and imaging data suggest that arterio-arterial embolism from nonstenosing atheroscle-rotic plaques may play a role in patients with cryptogenic stroke. Methods: 300 patients (age > 49 years) with DWI-positive lesions in the territory of a single internal carotid artery (ICA) and ipsi- or contralateral carotid artery plaques will be enrolled prospectively. For plaque characterization all patients receive high resolution-black-blood carotid MRI within 10 days after symptom onset with follow-up after 3 and 12 months. Outcomes: Primary outcome is the prevalence of complicated AHA-LT VI plaques in cryptogenic stroke patients ipsi- and contralateral to the ischemic stroke and compared to patients with defined stroke etiology. Secondary outcomes include the association of AHA-LT VI plaques with specific in-farct patterns, biomarkers and aortic arch plaques. Furthermore we will evaluate the recurrence rates of ischemic events and the influence of specific AHA-LT VI plaque features on the progression of atherosclerotic disease burden after 12 months. Results: Baseline data of the first 75 patients were evaluated; Stroke subtyping using the TOAST criteria showed the following distribution: 12% large artery atherosclerosis, 26% cardioembolic, 13% small vessel disease, 5% multiple potential causes and 44% cryptogenic. Prevalence of com-plicated AHA-LT VI plaques was significantly higher on the symptomatic side (32 % vs. 8 % for all patients and 27% vs. 3% for cryptogenic stroke; p< 0.0001, McNemar Test). Conclusions: Preliminary data suggest a high prevalence of complicated AHA-LT VI plaques in the ipsilateral carotid artery in patients with unilateral anterior circulation infarcts of unknown etiology. If confirmed in the whole cohort, this study might offer new diagnostic options and provide the basis for the planning of targeted interventional studies. 424 © 2013 S. Karger AG, Basel Scientific Programme 260 Etiology of stroke and risk factors Clopidogrel resistance due to CYP2C19*2 polymorphism: an overestimated concern in a stroke population? A. Alonso1, R. Kern2, M.G. Hennerici3, M. Fatar4 Department of Neurology, UniversitätsMedizin Mannheim, University of Heidelberg, Mann-heim, GERMANY1, Department of Neurology, UniversitätsMedizin Mannheim, University of Heidelberg, Mannheim, GERMANY2, Department of Neurology, UniversitätsMedizin Mannheim, University of Heidelberg, Mannheim, GERMANY3, Department of Neurology, UniversitätsMedizin Mannheim, University of Heidelberg, Mannheim, GERMANY4 Background. Cytochrome P450 (CYP) 2C19 is a crucial enzyme for metabolic bioactivation of clopidogrel. The CYP2C19*2 polymorphism has been associated with increased risk of major ad-verse cardiovascular events and coronary stent thrombosis. However, its significance for the risk of stroke and stroke recurrence is not well defined. Patients and Methods. Over a 1-year-period, we screened all patients admitted to our stroke com-prehensive center. Patients suffering stroke under medication with clopidogrel and patients whose antiplatelet therapy was changed to clopidogrel after stroke were analysed. CYP2C19 genotype was assessed using a point-of-care test system (Spartan RX). Results. 41 patients with acute ischemic stroke and cerebrovascular indication for clopidogrel were included. 23/41 were under treatment with clopidogrel at the time of onset. In 18/41, clopidogrel therapy was initiated after stroke. Out of these 18 patients, 8 received dual antiplatelet therapy with aspirin and clopidogrel due to progressive or instable carotid artery stenosis. Most common other reasons for prescription of clopidogrel were intolerance of aspirin and nonresponding platelet func-tion tests under aspirin. Overall, 26/41 (63%) had a wild-type *1/*1 genotype; 14/41 (34%) were heterozygous with a *1/*2 genotype. Out of the 23 patients with preexisting clopidogrel treatment, 8/23 (35%) were heterozy-gous. Only 1/41 showed a homozygous *2/*2 genotype. Conclusion. The rate of about 30% of CYP2C19*2 allel carriers in our population is consistent with previous studies. The percentage of *2 allel carriers was not increased in patients suffering stroke under clopidogrel treatment. Taking into account the limited number of acute stroke patients with an indication for clopidogrel treatment, we conclude that the impact of CYP2C19 polymorphism in stroke recurrence might be rather low. CYP2C19 genotype testing can therefore not be recommend-ed as a matter of routine so far.
Karger_ESC London_2013
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