Comparison of Warfarin and Aspirin for Symptomatic Intracranial Arterial Stenosis
Marc I. Chimowitz, M.B., Ch.B., Michael J. Lynn, M.S., Harriet Howlett-Smith, R.N., Barney J. Stern, M.D., Vicki S. Hertzberg, Ph.D., Michael R. Frankel, M.D., Steven R. Levine, M.D., Seemant Chaturvedi, M.D., Scott E. Kasner, M.D., Curtis G. Benesch, M.D., Cathy A. Sila, M.D., Tudor G. Jovin, M.D., Jose G. Romano, M.D., for the Warfarin–Aspirin Symptomatic Intracranial Disease Trial Investigators
Background Atherosclerotic intracranial arterial stenosis isan important cause of stroke. Warfarin is commonly used in preferenceto aspirin for this disorder, but these therapies have not beencompared in a randomized trial.
Methods We randomly assigned patients with transient ischemicattack or stroke caused by angiographically verified 50 to 99percent stenosis of a major intracranial artery to receive warfarin(target international normalized ratio, 2.0 to 3.0) or aspirin(1300 mg per day) in a double-blind, multicenter clinical trial.The primary end point was ischemic stroke, brain hemorrhage,or death from vascular causes other than stroke.
Results After 569 patients had undergone randomization, enrollmentwas stopped because of concerns about the safety of the patientswho had been assigned to receive warfarin. During a mean follow-upperiod of 1.8 years, adverse events in the two groups includeddeath (4.3 percent in the aspirin group vs. 9.7 percent in thewarfarin group; hazard ratio for aspirin relative to warfarin,0.46; 95 percent confidence interval, 0.23 to 0.90; P=0.02),major hemorrhage (3.2 percent vs. 8.3 percent, respectively;hazard ratio, 0.39; 95 percent confidence interval, 0.18 to0.84; P=0.01), and myocardial infarction or sudden death (2.9percent vs. 7.3 percent, respectively; hazard ratio, 0.40; 95percent confidence interval, 0.18 to 0.91; P=0.02). The rateof death from vascular causes was 3.2 percent in the aspiringroup and 5.9 percent in the warfarin group (P=0.16); the rateof death from nonvascular causes was 1.1 percent and 3.8 percent,respectively (P=0.05). The primary end point occurred in 22.1percent of the patients in the aspirin group and 21.8 percentof those in the warfarin group (hazard ratio, 1.04; 95 percentconfidence interval, 0.73 to 1.48; P=0.83).
Conclusions Warfarin was associated with significantly higherrates of adverse events and provided no benefit over aspirinin this trial. Aspirin should be used in preference to warfarinfor patients with intracranial arterial stenosis.
Source Information
From the Department of Neurology, School of Medicine (M.I.C., H.H.-S., B.J.S., M.R.F.), and the Department of Biostatistics, Rollins School of Public Health (M.J.L., V.S.H.), Emory University, Atlanta; the Department of Neurology, Mount Sinai School of Medicine, New York (S.R.L.); the Department of Neurology, Wayne State University, Detroit (S.C.); the Department of Neurology, University of Pennsylvania School of Medicine (S.E.K.); the Department of Neurology, University of Rochester School of Medicine, Rochester, N.Y. (C.G.B.); the Department of Neurology, Cleveland Clinic Foundation, Cleveland (C.A.S.); the Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh (T.G.J.); and the Department of Neurology, University of Miami Medical School, Miami (J.G.R.).
Address reprint requests to Dr. Chimowitz at the Department of Neurology, Emory Clinic, 4th Fl., Clinic A Bldg., 1365 Clifton Rd., Atlanta, GA 30322, or at mchimow{at}emory.edu.
Ovbiagele, B., Cruz-Flores, S., Lynn, M. J., Chimowitz, M. I., for the Warfarin-Aspirin Symptomatic Intracranial,
(2008). Early Stroke Risk After Transient Ischemic Attack Among Individuals With Symptomatic Intracranial Artery Stenosis. Arch Neurol
65: 733-737
[Abstract][Full Text]
Layton, K.F., Hise, J.H., Thacker, I.C.
(2008). Recurrent Intracranial Stenosis Induced by the Wingspan Stent: Comparison with Balloon Angioplasty Alone in a Single Patient. Am. J. Neuroradiol.
29: 1050-1052
[Abstract][Full Text]
Ansell, J., Hirsh, J., Hylek, E., Jacobson, A., Crowther, M., Palareti, G.
(2008). Pharmacology and Management of the Vitamin K Antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest
133: 160S-198S
[Abstract][Full Text]
Schulman, S., Beyth, R. J., Kearon, C., Levine, M. N.
(2008). Hemorrhagic Complications of Anticoagulant and Thrombolytic Treatment: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest
133: 257S-298S
[Abstract][Full Text]
Toyoda, K., Yasaka, M., Iwade, K., Nagata, K., Koretsune, Y., Sakamoto, T., Uchiyama, S., Gotoh, J., Nagao, T., Yamamoto, M., Takahashi, J. C., Minematsu, K., for the Bleeding with Antithrombotic Therapy (BAT),
(2008). Dual Antithrombotic Therapy Increases Severe Bleeding Events in Patients With Stroke and Cardiovascular Disease: A Prospective, Multicenter, Observational Study. Stroke
39: 1740-1745
[Abstract][Full Text]
Mazighi, M., Yadav, J. S., Abou-Chebl, A.
(2008). Durability of Endovascular Therapy for Symptomatic Intracranial Atherosclerosis. Stroke
39: 1766-1769
[Abstract][Full Text]
Arenillas, J. F., Alvarez-Sabin, J., Molina, C. A., Chacon, P., Fernandez-Cadenas, I., Ribo, M., Delgado, P., Rubiera, M., Penalba, A., Rovira, A., Montaner, J.
(2008). Progression of Symptomatic Intracranial Large Artery Atherosclerosis Is Associated With a Proinflammatory State and Impaired Fibrinolysis. Stroke
39: 1456-1463
[Abstract][Full Text]
O'Donnell, M. J., Hankey, G. J., Eikelboom, J. W.
(2008). Antiplatelet Therapy for Secondary Prevention of Noncardioembolic Ischemic Stroke: A Critical Review. Stroke
39: 1638-1646
[Abstract][Full Text]
Zaidat, O. O., Klucznik, R., Alexander, M. J., Chaloupka, J., Lutsep, H., Barnwell, S., Mawad, M., Lane, B., Lynn, M. J., Chimowitz, M., For the NIH Multi-center Wingspan Intracranial Ste,
(2008). The NIH registry on use of the Wingspan stent for symptomatic70-99% intracranial arterial stenosis. Neurology
70: 1518-1524
[Abstract][Full Text]
Haley, E. C. Jr
(2008). Registries: They're not just for weddings anymore. Neurology
70: 1508-1509
[Full Text]
Suh, D.C., Kim, J.K., Choi, J.W., Choi, B.S., Pyun, H.W., Choi, Y.J., Kim, M.-H., Yang, H.R., Ha, H.I., Kim, S.J., Lee, D.H., Choi, C.G., Hahm, K.D., Kim, J.S.
(2008). Intracranial Stenting of Severe Symptomatic Intracranial Stenosis: Results of 100 Consecutive Patients. Am. J. Neuroradiol.
29: 781-785
[Abstract][Full Text]
Nguyen-Huynh, M. N., Wintermark, M., English, J., Lam, J., Vittinghoff, E., Smith, W. S., Johnston, S. C.
(2008). How Accurate Is CT Angiography in Evaluating Intracranial Atherosclerotic Disease?. Stroke
39: 1184-1188
[Abstract][Full Text]
Mazighi, M., Labreuche, J., Gongora-Rivera, F., Duyckaerts, C., Hauw, J.-J., Amarenco, P.
(2008). Autopsy Prevalence of Intracranial Atherosclerosis in Patients With Fatal Stroke. Stroke
39: 1142-1147
[Abstract][Full Text]
Nahab, F., Cotsonis, G., Lynn, M., Feldmann, E., Chaturvedi, S., Hemphill, J. C., Zweifler, R., Johnston, K., Bonovich, D., Kasner, S., Chimowitz, M., for the WASID Study Group,
(2008). Prevalence and Prognosis of Coexistent Asymptomatic Intracranial Stenosis. Stroke
39: 1039-1041
[Abstract][Full Text]
Hertzberg, V., Chimowitz, M., Lynn, M., Chester, C., Asbury, W., Cotsonis, G.
(2008). Use of dose modification schedules is effective for blinding trials of warfarin: evidence from the WASID study. Clin Trials
5: 23-30
[Abstract]
Puetz, V., Gahn, G., Becker, U., Mucha, D., Mueller, A., Weir, N.U., Wiedemann, B., von Kummer, R.
(2008). Endovascular Therapy of Symptomatic Intracranial Stenosis in Patients With Impaired Regional Cerebral Blood Flow or Failure of Medical Therapy. Am. J. Neuroradiol.
29: 273-280
[Abstract][Full Text]
Valaikiene, J., Schuierer, G., Ziemus, B., Dietrich, J., Bogdahn, U., Schlachetzki, F.
(2008). Transcranial Color-Coded Duplex Sonography for Detection of Distal Internal Carotid Artery Stenosis. Am. J. Neuroradiol.
29: 347-353
[Abstract][Full Text]
Abruzzo, T., Tong, F., Dion, J. E., Workman, M., Cloft, H. J.
(2008). Reply:. Am. J. Neuroradiol.
29: 6-6
[Full Text]
Turk, A.S., Levy, E.I., Albuquerque, F.C., Pride, G.L. Jr, Woo, H., Welch, B.G., Niemann, D.B., Purdy, P.D., Aagaard-Kienitz, B., Rasmussen, P.A., Hopkins, L.N., Masaryk, T.J., McDougall, C.G., Fiorella, D.
(2008). Influence of Patient Age and Stenosis Location on Wingspan In-Stent Restenosis. Am. J. Neuroradiol.
29: 23-27
[Abstract][Full Text]
Sharma, V. K., Tsivgoulis, G., Lao, A. Y., Malkoff, M. D., Alexandrov, A. V.
(2007). Noninvasive Detection of Diffuse Intracranial Disease. Stroke
38: 3175-3181
[Abstract][Full Text]
Marler, J. R.
(2007). NINDS Clinical Trials in Stroke: Lessons Learned and Future Directions. Stroke
38: 3302-3307
[Abstract][Full Text]
Chaturvedi, S., Turan, T. N., Lynn, M. J., Kasner, S. E., Romano, J., Cotsonis, G., Frankel, M., Chimowitz, M. I., For the WASID Study Group,
(2007). Risk factor status and vascular events in patients with symptomatic intracranial stenosis. Neurology
69: 2063-2068
[Abstract][Full Text]
The Stroke Risk in Atrial Fibrillation Working Gro,
(2007). Independent predictors of stroke in patients with atrial fibrillation: A systematic review. Neurology
69: 546-554
[Abstract][Full Text]
Fiorella, D., Woo, H. H.
(2007). Emerging Endovascular Therapies for Symptomatic Intracranial Atherosclerotic Disease. Stroke
38: 2391-2396
[Full Text]
Williams, J. E., Chimowitz, M. I., Cotsonis, G. A., Lynn, M. J., Waddy, S. P., for the WASID Investigators,
(2007). Gender Differences in Outcomes Among Patients With Symptomatic Intracranial Arterial Stenosis. Stroke
38: 2055-2062
[Abstract][Full Text]
Feldmann, E., Wilterdink, J. L., Kosinski, A., Lynn, M., Chimowitz, M. I., Sarafin, J., Smith, H. H., Nichols, F., Rogg, J., Cloft, H. J., Wechsler, L., Saver, J., Levine, S. R., Tegeler, C., Adams, R., Sloan, M., The Stroke Outcomes and Neuroimaging of Intracrani,
(2007). The Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) Trial. Neurology
68: 2099-2106
[Abstract][Full Text]
Turan, T. N., Cotsonis, G., Lynn, M. J., Chaturvedi, S., Chimowitz, M., for the Warfarin-Aspirin Symptomatic Intracranial,
(2007). Relationship Between Blood Pressure and Stroke Recurrence in Patients With Intracranial Arterial Stenosis. Circulation
115: 2969-2975
[Abstract][Full Text]
Bang, O. Y., Saver, J. L., Ovbiagele, B., Choi, Y. J., Yoon, S. R., Lee, K. H.
(2007). Adiponectin levels in patients with intracranial atherosclerosis. Neurology
68: 1931-1937
[Abstract][Full Text]
Oake, N., Fergusson, D. A., Forster, A. J., van Walraven, C.
(2007). Frequency of adverse events in patients with poor anticoagulation: a meta-analysis. CMAJ
176: 1589-1594
[Abstract][Full Text]
Abruzzo, T.A., Tong, F.C., Waldrop, A.S.M., Workman, M.J., Cloft, H.J., Dion, J.E.
(2007). Basilar Artery Stent Angioplasty for Symptomatic Intracranial Athero-Occlusive Disease: Complications and Late Midterm Clinical Outcomes. Am. J. Neuroradiol.
28: 808-815
[Abstract][Full Text]
Jiang, W.-J., Xu, X.-T., Jin, M., Du, B., Dong, K.-H., Dai, J.-P.
(2007). Apollo Stent for Symptomatic Atherosclerotic Intracranial Stenosis: Study Results. Am. J. Neuroradiol.
28: 830-834
[Abstract][Full Text]
Aronow, W. S.
(2007). Use of Antiplatelet Drugs in Secondary Prevention in Older Persons With Atherothrombotic Disease. J. Gerontol. A Biol. Sci. Med. Sci.
62: 518-524
[Abstract][Full Text]
van Walraven, C., Oake, N., Wells, P. S., Forster, A. J.
(2007). Burden of Potentially Avoidable Anticoagulant-Associated Hemorrhagic and Thromobembolic Events in the Elderly. Chest
131: 1508-1515
[Abstract][Full Text]
Bose, A., Hartmann, M., Henkes, H., Liu, H. M., Teng, M. M.H., Szikora, I., Berlis, A., Reul, J., Yu, S. C.H., Forsting, M., Lui, M., Lim, W., Sit, S. P.
(2007). A Novel, Self-Expanding, Nitinol Stent in Medically Refractory Intracranial Atherosclerotic Stenoses: The Wingspan Study. Stroke
38: 1531-1537
[Abstract][Full Text]
Leung, T. W., Mak, H., Yu, S. C.H., Wong, K.-s., Jiang, W.-J., Gao, F.
(2007). Perforator stroke after elective stenting of symptomatic intracranial stenosis. Neurology
68: 1237-1237
[Full Text]
Jiang, W.-J., Du, B., Leung, T. W., Xu, X.-T., Jin, M., Dong, K.-H.
(2007). Symptomatic Intracranial Stenosis: Cerebrovascular Complications from Elective Stent Placement. Radiology
243: 188-197
[Abstract][Full Text]
Donnan, G. A., Davis, S. M.
(2007). Stenting for Middle Cerebral Artery Stenosis: Inevitable but When and How. Stroke
38: 1422-1422
[Full Text]
Liu, M., Li, W., Liu, Z.-Q.
(2007). Middle Cerebral Artery Stenosis: Stenting Is One of the Options: Yes. Stroke
38: 1418-1419
[Full Text]
Kasner, S. E.
(2007). Middle Cerebral Artery Stenosis: Stenting Is One of the Options: No. Stroke
38: 1420-1421
[Full Text]
Jiang, W. J., Xu, X. T., Du, B., Dong, K. H., Jin, M., Wang, Q. H., Ma, N.
(2007). Long-term outcome of elective stenting for symptomatic intracranial vertebrobasilar stenosis. Neurology
68: 856-858
[Abstract][Full Text]
Fiorella, D., Levy, E. I., Turk, A. S., Albuquerque, F. C., Niemann, D. B., Aagaard-Kienitz, B., Hanel, R. A., Woo, H., Rasmussen, P. A., Hopkins, L. N., Masaryk, T. J., McDougall, C. G.
(2007). US Multicenter Experience With the Wingspan Stent System for the Treatment of Intracranial Atheromatous Disease: Periprocedural Results. Stroke
38: 881-887
[Abstract][Full Text]
Rothwell, P M
(2007). Atherothrombosis and ischaemic stroke. BMJ
334: 379-380
[Full Text]
Jiang, W. J., Xu, X. T., Du, B., Dong, K. H., Jin, M., Wang, Q. H., Ma, N.
(2007). Comparison of elective stenting of severe vs moderate intracranial atherosclerotic stenosis. Neurology
68: 420-426
[Abstract][Full Text]
Cruz-Flores, S., Mazighi, M ., Ducrocq, X ., Bracard, S ., Houdart, E ., Woimant, F .
(2007). Prospective study of symptomatic atherothrombotic intracranial stenoses: the GESICA study.. Neurology
68: 241-242
[Full Text]
Flaherty, M. L., Kissela, B., Woo, D., Kleindorfer, D., Alwell, K., Sekar, P., Moomaw, C. J., Haverbusch, M., Broderick, J. P.
(2007). The increasing incidence of anticoagulant-associated intracerebral hemorrhage. Neurology
68: 116-121
[Abstract][Full Text]
Kang, D.-W., Kwon, S. U., Yoo, S.-H., Kwon, K.-Y., Choi, C. G., Kim, S. J., Koh, J.-Y., Kim, J. S.
(2007). Early Recurrent Ischemic Lesions on Diffusion-Weighted Imaging in Symptomatic Intracranial Atherosclerosis. Arch Neurol
64: 50-54
[Abstract][Full Text]
Kang, D.-W., Lattimore, S. U., Latour, L. L., Warach, S.
(2006). Silent Ischemic Lesion Recurrence on Magnetic Resonance Imaging Predicts Subsequent Clinical Vascular Events. Arch Neurol
63: 1730-1733
[Abstract][Full Text]
Basaviah, P., Frost, S.
(2006). Update in hospital medicine.. ANN INTERN MED
145: 685-691
[Full Text]
Hankey, G. J., Cruz-Flores, S., Diamond, A. L.
(2006). Angioplasty With or Without Stenting for Intracranial Artery Stenosis. Stroke
37: 2858-2859
[Full Text]
Nam, H. S., Han, S. W., Lee, J. Y., Ahn, S. H., Ha, J. W., Rim, S. J., Lee, B. I., Heo, J. H.
(2006). Association of aortic plaque with intracranial atherosclerosis in patients with stroke.. Neurology
67: 1184-1188
[Abstract][Full Text]
Kasner, S. E., Lynn, M. J., Chimowitz, M. I., Frankel, M. R., Howlett-Smith, H., Hertzberg, V. S., Chaturvedi, S., Levine, S. R., Stern, B. J., Benesch, C. G., Jovin, T. G., Sila, C. A., Romano, J. G., for the Warfarin Aspirin Symptomatic Intracranial,
(2006). Warfarin vs aspirin for symptomatic intracranial stenosis: Subgroup analyses from WASID.. Neurology
67: 1275-1278
[Abstract][Full Text]
Wojak, J.C., Dunlap, D.C., Hargrave, K.R., DeAlvare, L.A., Culbertson, H.S., Connors, J.J. III
(2006). Intracranial angioplasty and stenting: long-term results from a single center.. Am. J. Neuroradiol.
27: 1882-1892
[Abstract][Full Text]
Gupta, R., Al-Ali, F., Thomas, A. J., Horowitz, M. B., Barrow, T., Vora, N. A., Uchino, K., Hammer, M. D., Wechsler, L. R., Jovin, T. G.
(2006). Safety, Feasibility, and Short-Term Follow-Up of Drug-Eluting Stent Placement in the Intracranial and Extracranial Circulation. Stroke
37: 2562-2566
[Abstract][Full Text]
Weimar, C., Goertler, M., Harms, L., Diener, H.-C., for the German Stroke Study Collaboration,
(2006). Distribution and outcome of symptomatic stenoses and occlusions in patients with acute cerebral ischemia.. Arch Neurol
63: 1287-1291
[Abstract][Full Text]
Meyers, P. M., Phatouros, C. C., Higashida, R. T.
(2006). Hyperperfusion Syndrome After Intracranial Angioplasty and Stent Placement. Stroke
37: 2210-2211
[Full Text]
Marder, V. J., Chute, D. J., Starkman, S., Abolian, A. M., Kidwell, C., Liebeskind, D., Ovbiagele, B., Vinuela, F., Duckwiler, G., Jahan, R., Vespa, P. M., Selco, S., Rajajee, V., Kim, D., Sanossian, N., Saver, J. L.
(2006). Analysis of Thrombi Retrieved From Cerebral Arteries of Patients With Acute Ischemic Stroke. Stroke
37: 2086-2093
[Abstract][Full Text]
Levy, E. I., Chaturvedi, S.
(2006). Perforator stroke following intracranial stenting: A sacrifice for the greater good?. Neurology
66: 1803-1804
[Full Text]
Ovbiagele, B., Saver, J. L., Lynn, M. J., Chimowitz, M., for the WASID Study Group,
(2006). Impact of metabolic syndrome on prognosis of symptomatic intracranial atherostenosis. Neurology
66: 1344-1349
[Abstract][Full Text]
Mazighi, M., Tanasescu, R., Ducrocq, X., Vicaut, E., Bracard, S., Houdart, E., Woimant, F.
(2006). Prospective study of symptomatic atherothrombotic intracranial stenoses: The GESICA Study. Neurology
66: 1187-1191
[Abstract][Full Text]
Marks, M. P., Wojak, J. C., Al-Ali, F., Jayaraman, M., Marcellus, M. L., Connors, J. J., Do, H. M.
(2006). Angioplasty for Symptomatic Intracranial Stenosis: Clinical Outcome. Stroke
37: 1016-1020
[Abstract][Full Text]
Sacco, R. L., Adams, R., Albers, G., Alberts, M. J., Benavente, O., Furie, K., Goldstein, L. B., Gorelick, P., Halperin, J., Harbaugh, R., Johnston, S. C., Katzan, I., Kelly-Hayes, M., Kenton, E. J., Marks, M., Schwamm, L. H., Tomsick, T.
(2006). Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline.. Circulation
113: e409-e449
[Abstract][Full Text]
Sacco, R. L., Adams, R., Albers, G., Alberts, M. J., Benavente, O., Furie, K., Goldstein, L. B., Gorelick, P., Halperin, J., Harbaugh, R., Johnston, S. C., Katzan, I., Kelly-Hayes, M., Kenton, E. J., Marks, M., Schwamm, L. H., Tomsick, T.
(2006). Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline.. Stroke
37: 577-617
[Abstract][Full Text]
Kasner, S. E., Chimowitz, M. I., Lynn, M. J., Howlett-Smith, H., Stern, B. J., Hertzberg, V. S., Frankel, M. R., Levine, S. R., Chaturvedi, S., Benesch, C. G., Sila, C. A., Jovin, T. G., Romano, J. G., Cloft, H. J., for the Warfarin Aspirin Symptomatic Intracranial,
(2006). Predictors of Ischemic Stroke in the Territory of a Symptomatic Intracranial Arterial Stenosis. Circulation
113: 555-563
[Abstract][Full Text]
Michel, P, Bogousslavsky, J
(2006). Shared mechanisms of ischaemic and haemorrhagic stroke: still a lot to learn. J. Neurol. Neurosurg. Psychiatry
77: 1-1
[Full Text]
Touze, E., Varenne, O., Chatellier, G., Peyrard, S., Rothwell, P. M., Mas, J.-L.
(2005). Risk of Myocardial Infarction and Vascular Death After Transient Ischemic Attack and Ischemic Stroke: A Systematic Review and Meta-Analysis. Stroke
36: 2748-2755
[Abstract][Full Text]
Nighoghossian, N., Derex, L., Douek, P.
(2005). The Vulnerable Carotid Artery Plaque: Current Imaging Methods and New Perspectives. Stroke
36: 2764-2772
[Abstract][Full Text]
Kirshner, H. S., Biller, J., Callahan, A. S. III
(2005). Long-Term Therapy to Prevent Stroke. J Am Board Fam Med
18: 528-540
[Abstract][Full Text]
Jea, A., Smith, E. R., Robertson, R., Scott, R. M.
(2005). Moyamoya Syndrome Associated With Down Syndrome: Outcome After Surgical Revascularization. Pediatrics
116: e694-e701
[Abstract][Full Text]
Yoon, W., Seo, J. J., Cho, K. H., Kim, M. K., Kim, B. C., Park, M. S., Kim, T. S., Kim, J. K., Kang, H. K.
(2005). Symptomatic Middle Cerebral Artery Stenosis Treated with Intracranial Angioplasty: Experience in 32 Patients. Radiology
237: 620-626
[Abstract][Full Text]
(2005). Intracranial Angioplasty & Stenting for Cerebral Atherosclerosis: A Position Statement of the American Society of Interventional and Therapeutic Neuroradiology, Society of Interventional Radiology, and the American Society of Neuroradiology. Am. J. Neuroradiol.
26: 2323-2327
[Full Text]
Eikelboom, J. W
(2005). Warfarin was not more effective than aspirin and increased adverse events in symptomatic intracranial arterial stenosis. Evid. Based Med.
10: 136-136
[Full Text]
Kern, R., Steinke, W., Daffertshofer, M., Prager, R., Hennerici, M.
(2005). Stroke recurrences in patients with symptomatic vs asymptomatic middle cerebral artery disease. Neurology
65: 859-864
[Abstract][Full Text]
Bushnell, C. D., Guzick, D.
(2005). Metabolic syndrome and intracranial atherosclerosis: A new link?. Neurology
65: 188-189
[Full Text]
Alberts, M. J., Latchaw, R. E., Selman, W. R., Shephard, T., Hadley, M. N., Brass, L. M., Koroshetz, W., Marler, J. R., Booss, J., Zorowitz, R. D., Croft, J. B., Magnis, E., Mulligan, D., Jagoda, A., O'Connor, R., Cawley, C. M., Connors, J.J., Rose-DeRenzy, J. A., Emr, M., Warren, M., Walker, M. D., for the Brain Attack Coalition,
(2005). Recommendations for Comprehensive Stroke Centers: A Consensus Statement From the Brain Attack Coalition. Stroke
36: 1597-1616
[Abstract][Full Text]
Hart, R. G., Tonarelli, S. B., Pearce, L. A.
(2005). Avoiding Central Nervous System Bleeding During Antithrombotic Therapy: Recent Data and Ideas. Stroke
36: 1588-1593
[Abstract][Full Text]
Savitz, S. I., Caplan, L. R.
(2005). Vertebrobasilar Disease. NEJM
352: 2618-2626
[Full Text]
(2005). Warfarin vs. Aspirin for Symptomatic Intracranial Arterial Stenosis. JWatch Neurology
2005: 2-2
[Full Text]
Malik, I.
(2005). JournalScan. Heart
91: 847-848
[Full Text]
(2005). Warfarin or Aspirin for Intracranial Arterial Stenosis?. JWatch General
2005: 4-4
[Full Text]
Koroshetz, W. J.
(2005). Warfarin, Aspirin, and Intracranial Vascular Disease. NEJM
352: 1368-1370
[Full Text]
Previous
