Characteristics and causes of recurrent ischemic events in minor ischemic stroke and TIA in the READAPT study

Background and purpose: Understanding the causes of recurrent ischemic events in patients with minor stroke or high-risk TIA is crucial to understand unmet needs in secondary prevention. This study examines the characteristics and causes of recurrences after non-cardioembolic minor stroke/high-risk TIA in patients treated with the best medical care. Methods: This subgroup analysis from a prospective real-world study (READAPT, NCT05476081) included patients with non-cardioembolic minor ischemic stroke (NIHSS ≤5) or TIA (ABCD2 score ≥ 4), receiving short-term DAPT. We described the etiologic distribution according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification of the index and of the recurrent event. We analyzed baseline characteristics of patients with and without a 90-day ischemic recurrence to identify factors linked to recurrence. Results: Out of 1641 patients, 56 (3.4 %) had a recurrent ischemic event (35 strokes and 21 TIAs). The cause of recurrences was undetermined in 21 (37.5 %), small vessel occlusion in 18 (32.1 %), large artery atherosclerosis in 11 (19.6 %), other determined in 3 (5.4 %), and cardioembolism in 3 (5.4 %). The etiologic distribution of recurrent events differed from that of the corresponding index events (p = 0.002). Non-compliance to DAPT was more prevalent in patients with recurrences compared with those without (8.9 % vs 3.7 %, p = 0.048). Conclusions: Patients with recurrences after a minor stroke or high-risk TIA have a different etiologic distribution compared with their index events. Additionally, a lower compliance to DAPT was observed in those with recurrences, suggesting that adherence to DAPT should be encouraged to optimize the outcome of patients.