BACKGROUND Branch atheromatous disease (BAD) is distinctive from large and small arterial diseases, which is single subcortical infarction larger than lacunar stroke in the territories of deep perforators without relevant arterial stenosis. BAD meets the current criteria of embolic stroke of undetermined source. We performed an exploratory analysis of BAD in patients recruited to NAVIGATE embolic stroke of undetermined source, a randomized controlled trial to compare rivaroxaban and aspirin in embolic stroke of undetermined source patients. METHODS AND RESULTS Among 3972 stroke patients in cerebral hemispheres with intracranial arterial imaging, 502 (12.6%) patients met the criteria for BAD. BAD was associated with younger age (years; OR: 0.97, 95% CI: 0.96-0.98), race (Asian; OR: 1.78, 95% CI: 1.44-2.21), region (Eastern Europe; OR: 2.49, 95% CI: 1.87-3.32), and higher National Institute of Health Stroke Scale (OR: 1.17, 95% CI: 1.12-1.22) at randomization. During follow-up, stroke or systemic embolism (2.5%/year vs. 6.2%/year, p = 0.0022), stroke (2.1%/year vs. 6.2%/year, p = 0.0008), and ischemic stroke (2.1%/year vs. 5.9%/year, p = 0.0013) occurred less frequently in BAD than non-BAD patients. There were no differences in annual rates of stroke or systemic embolism (2.5%/year vs. 2.5%/year, HR: 1.01, 95% CI: 0.33-3.14) or major bleeding (1.3%/year vs. 0.8%/year, HR: 1.51, 95% CI: 0.25-9.05) between rivaroxaban and aspirin groups among BAD patients. CONCLUSIONS BAD was relatively common, especially in Asian and from Eastern Europe among embolic stroke of undetermined source patients. Stroke severity was higher at randomization but recurrence of stroke was fewer in BAD than non-BAD patients. The efficacy and safety of rivaroxaban and aspirin did not differ among BAD patients.

中文翻译：

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被诊断为来源不明的栓塞性中风的分支动脉粥样硬化疾病：NAVIGATE ESUS的子分析。

背景技术分支动脉粥样硬化性疾病（BAD）与大动脉和小动脉疾病不同，后者是深部穿支孔区域内比腔隙中风大的单个皮质下梗死，而没有相关的动脉狭窄。BAD符合目前不确定来源的栓塞性卒中标准。我们对招募到未确定来源的NAVIGATE栓塞性卒中的患者进行了BAD的探索性分析，这是一项随机对照试验，比较了利伐沙班和阿司匹林在未确定来源的栓塞性中风中的患者。方法和结果在3972例脑半球颅内动脉影像学卒中患者中，有502例（12.6％）符合BAD标准。BAD与年龄较小（年龄; OR：0.97，95％CI：0.96-0.98），种族（亚洲; OR：1.78，95％CI：1.44-2.21），地区（东欧; OR：2.49，95％）相关CI：1.87-3.32）和更高的国家卫生研究院卒中量表（OR：1.17，95％CI：1.12-1.22）。在随访期间，中风或全身性栓塞（2.5％/年vs. 6.2％/年，p = 0.0022），中风（2.1％/年vs. 6.2％/年，p = 0.0008）和缺血性中风（2.1％ /年vs. 5.9％/年，p = 0.0013）在BAD中的发生频率比非BAD患者低。中风或全身性栓塞的年发生率（2.5％/年vs. 2.5％/年，HR：1.01，95％CI：0.33-3.14）或大出血（1.3％/年vs. 0.8％/年）没有差异，在BAD患者中，利伐沙班和阿司匹林组之间的HR：1.51，95％CI：0.25-9.05）。结论未定来源患者的栓塞性卒中不良反应相对普遍，尤其是在亚洲和东欧。在随机分组中，卒中严重程度较高，但与非BAD患者相比，BAD中风的复发较少。利伐沙班和阿司匹林的疗效和安全性在BAD患者之间没有差异。