NUANCE-ICAD

For any study related questions please call Dr. Mark Boulos at (416)-433-5653

Inclusion Criteria

1. Age ≥ 40 years old, male and female.

2. TIA or ischemic stroke secondary to symptomatic atherosclerotic stenosis of 30-99% involving the intracranial ICA or MCA or posterior circulation arteries as evidenced by CT or MR angiography.

3. Index TIA or ischemic stroke event occurred within past 30 days.

4. Clinical indication for DAPT for at least 3 months.

Exclusion Criteria

1. Any contraindication to DAPT.

2. Any contraindication to use of clopidogrel or ticagrelor, such as pregnancy. A pregnancy test will be performed on all women of child-bearing age prior to enrollment in the study.

3. Indication for chronic anticoagulation based on guideline recommendations or investigator’s judgment (e.g., atrial fibrillation, mechanical heart valve, intracardiac clot, dilated cardiomyopathy, ejection fraction <30%, etc.).

4. Intracranial arterial occlusion (i.e. 100% stenosis) responsible for the acute brain ischemia.

5. Intracranial arterial stenosis secondary to causes other atherosclerosis. 

6. Extracranial carotid disease with a plan for carotid revascularization.

7. Intraluminal thrombus.

8. Subdural hematoma within 12 months of randomization not amenable to embolization.

9. Previous spontaneous hemorrhagic stroke.

10. Traumatic brain hemorrhage within 1 month of randomization.

11. Living in a nursing home or requiring daily nursing care or assistance with activities of daily living.

12. Intracranial tumor (except meningioma) or any intracranial vascular malformation.

13. Life expectancy less than 6 months.

14. Enrolment in another study that would conflict with the current study.

Template for Sunnycare note:

Patient was enrolled in the NUANCE-ICAD Trial on [date] at [time]. They meet all inclusion and no exclusion criteria. Informed consent obtained from [patient/SDM/deferral] by [staff name]. Consent obtained prior to any study related procedures being performed. They have been advised of the risks and potential benefits and given adequate time to ask study related questions. No questions asked/no concerns. Consent obtained at [time]. Patient was randomized to the [comparator arm or experimental/genetic testing arm].