Aspirin for Prevention of Stroke After Endovascular Aortic Arch Repair: a Multicenter, Double-Blind, Randomized Controlled Trial

Summary

ABSTRACT Introduction Endovascular aortic arch repair (EAAR) and the endovascular reconstruction of arch branch vessels represent a new trend in managing aortic arch pathologies, due to advantages such as minimal invasiveness, rapid recovery, and fewer complications. However, stroke is a common and serious complication during EAAR procedures. Strategies for its prevention, including the question of whether antiplatelet therapy should be administered postoperatively, have not yet been reported.

Methods and analysis This project is designed as a prospective, multicenter, double-blind, randomized controlled trial. Patients undergoing Endovascular Aortic Arch Repair (EAAR) will be randomly assigned to three groups: aspirin treatment for 3 months, 6 months, or 1 year. All three groups will be followed up on for over one year. The primary endpoint is the incidence of postoperative stroke, while secondary endpoints include the patency rate of reconstructed supra-aortic branches, the incidence of major bleeding complications, EAAR-related complications, and the incidence of postoperative cognitive impairment. The study aims to evaluate the efficacy and safety of aspirin in preventing stroke after EAAR.

Furthermore, stratified analyses will be conducted based on factors such as reconstruction techniques, the number of reconstructed branch arteries, and the diameter of branch stents to explore their impact on stroke incidence post-EAAR. The clinical utility of aspirin in different subgroups will also be assessed to provide more precise and personalized treatment strategies for clinical practice.

Ethics and dissemination This study has been approved by the Western Theater Command General Hospital and will be conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval has been obtained separately from all participating research centers.

STRENGTHS AND LIMITATIONS OF THIS STUDY Endovascular aortic arch repair (EAAR) and endovascular reconstruction of the aortic arch branches have emerged as a new trend in managing aortic arch pathologies, owing to advantages such as minimal invasiveness, rapid recovery, and fewer complications. Stroke is a common and serious complication during EAAR procedures; however, strategies for its prevention, including the need for postoperative antiplatelet therapy, have not been well documented.

This project aims to conduct a prospective, multicenter randomized controlled trial to evaluate the efficacy and safety of aspirin in preventing stroke following EAAR, thereby providing evidence for clinical decision-making and improving long-term patient outcomes. As the trial will be conducted in China, where the population is predominantly Han Chinese, the generalizability of the findings may be limited.

Conditions

• Type B or Non-A Non-B Aortic Dissection;Thoracic Aortic Aneurysm

Interventions

DRUG

enteric-coated aspirin tablets (100 mg once daily, Bayer Healthcare, specification: 100 mg/tablet)

Patients are randomized into three groups using a random number table or lottery method: Aspirin 3-month group, Aspirin 6-month group, Aspirin 1-year group. Every group begin oral administration of aspirin enteric-coated tablets 100 mg once daily (qd) (Bayer Healthcare Co., Ltd., specification: 100 mg/tablet) on the first postoperative day. Aspirin 3-month group will receive the investigational drug for 3 months followed by placebo for 9 months; Aspirin 6-month group will receive the investigational drug for 6 months followed by placebo for 6 months; Aspirin 1-year will receive the investigational drug for 1 year).

OTHER

a placebo with identical or similar appearance, taste, smell, and packaging to the aspirin tablets

The placebo's smell, color, taste, and packaging are identical or very similar to the aspirin enteric-coated tablets (Shandong Xinhua Pharmaceutical Co., Ltd., one of the world's largest producers of aspirin API and finished dosage forms. The company has extensive tablet manufacturing experience and GMP certification. Specifications regarding the appearance \[size, color, shape\], weight, taste, etc., of the placebo have been clearly defined to ensure it is completely identical to the aspirin tablets used in the study).

Sponsors & Collaborators

• The General Hospital of Western Theater Command

  lead OTHER

Study Design

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

QUADRUPLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2026-02-20

Primary Completion

2028-01-20

Completion

2028-09-20