Treat Stroke to Target (TST)
Ischemic Stroke, Transient Ischemic Attack, Atherosclerotic Stenosis
About this trial
This is an interventional prevention trial for Ischemic Stroke focused on measuring LDL-C, Cholesterol, Stroke, Transient ischemic attack, Statin, Lipid lowering therapy
Eligibility Criteria
Inclusion Criteria:
- • Recent (less than 3 months) ischemic stroke
- As soon as possible after the event, once the neurologic deficit is stabilized (investigator judgment)
These ischemic strokes include TIA with ischemic lesion documented by CT or MRI
• Or recent TIA (less than 15 days)
- without documentation of ischemic lesion on CT/MR imaging
Must be limb weakness or aphasia lasting more than 10 min
• And documented atherosclerotic stenosis
- In carotid artery (investigator judgment) (based on the results of Duplex echography, CTA, MRA or X ray- angiography)
- Or in the aortic arch (investigator judgment) (based on TEE or CTA)
- Or in other brain artery: vertebral, basilar or other intracranial artery (based on CTA, MRA, XRA)
Or in coronary arteries (past history of acute coronary syndrome, coronary revascularization or positive coronary angiography)
• And
- Statin treatment is indicated, following ANSM guidelines (French drug agency)
- age >18 years
- rankin score ≤ 4
- patient or a legal representative signs consent
- Patient is affiliated to social security system
Exclusion Criteria:
- • Ischemic stroke/TIA du to
- arterial dissection (investigator judgment)
Cardiac source of embolism (e.g., mitral stenosis, endomyocardial fibrosis) without documented atherosclerotic stenosis : a patient with atrial fibrillation or a past history of recent myocardial infarction or calcified aortic stenosis can be randomized if he otherwise fulfils inclusion criteria
• Symptomatic hemorrhagic stroke
- Presence of microbleeds on gradient echo imaging (T2*) is not an exclusion criteria.
Hemorrhagic transformation of an ischemic stroke is not an exclusion criteria
- Uncontrolled hypertension (investigator judgment)
- LDL-C <100 mg/dL or patients for whom treatment intensification is impossible
- F/U impossible or bad observance anticipated.
- Co-morbid condition that may interfere with the F/U or with the evaluation of primary endpoint
- Participation to another clinical trial
Sites / Locations
- BICHAT HOSPITAL Departement of Neurology
- BICHAT HOSPITAL Department of neurology and stroke center
Arms of the Study
Arm 1
Arm 2
Other
Other
LDL-C to100 mg/dL (+/-10 mg/dL)
LDL-C < 70 mg/dL
Target : 100 mg/dL (+/-10 mg/dL): Patients recruited in this arm will receive statin +/-other lipid lowering therapy in order to reach a LDL-C concentration of 100 mg/dL(+/-10 mg/dL).
70 mg/dL: Patients recruited in this arm will receive statin +/-other lipid lowering therapy in order to reach a LDL-C concentration of less than 70 mg/dL.