Background And Purpose: Cerebral small vessel disease (CSVD) is the most common cause of vascular dementia and a major contributor to mixed dementia. CSVD is characterized by progressive cerebral white matter changes (WMC) due to chronic low perfusion and loss of autoregulation. In addition to its antiplatelet effect, cilostazol exerts a vasodilating effect and improves endothelial function. This study aims to compare the effects of cilostazol and aspirin on changes in WMC volume in CSVD.
Methods: The comparison study of Cilostazol and aspirin on cHAnges in volume of cerebral smaLL vEssel disease white matter chaNGEs (CHALLENGE) is a double blind, randomized trial involving 19 hospitals across South Korea. Patients with moderate or severe WMC and ≥ 1 lacunar infarction detected on brain magnetic resonance imaging (MRI) are eligible; the projected sample size is 254. Participants are randomly assigned to a cilostazol or aspirin group at a 1:1 ratio. Cilostazol slow release 200 mg or aspirin 100 mg are taken once daily for 2 years. The primary outcome measure is the change in WMC volume on MRI from baseline to 104 weeks. Secondary imaging outcomes include changes in the number of lacunes and cerebral microbleeds, fractional anisotropy and mean diffusivity on diffusion tensor imaging, and brain atrophy. Secondary clinical outcomes include all ischemic strokes, all vascular events, and changes in cognition, motor function, mood, urinary symptoms, and disability.
Conclusions: CHALLENGE will provide evidence to support the selection of long-term antiplatelet therapy in CSVD.
Trial Registration: ClinicalTrials.gov Identifier: NCT01932203.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6946612 | PMC |
| http://dx.doi.org/10.12779/dnd.2019.18.4.138 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Rationale and design of the efficacy and safety of combination of cilostazol and gingko biloba extract EGb 761 in patients with acute non-cardioembolic ischemic stroke (RENEW): A pilot and feasibility randomized controlled trial.
J Stroke Cerebrovasc Dis
November 2024
Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, South Korea. Electronic address:
Background: Dual antiplatelet therapy with aspirin and clopidogrel is the standard treatment for acute ischemic stroke (AIS). Cilostazol has emerged as a safe alternative with pleiotropic effects that prevent stroke without increasing the risk of bleeding and has been shown to reduce neurological deterioration (ND) in the acute phase. Ginkgo biloba extract (EGb 761) has also been reported to improve neurological impairment following AIS.
View Article and Find Full Text PDFAortic arch atheroma and stroke recurrence in mild stroke patients: ADS post-hoc analysis.
J Clin Neurosci
October 2023
Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Background: Aortic arch atheroma is one of the embolic sources in patients with ischemic stroke. Although transesophageal echocardiogram (TEE) is the golden standard to evaluate the aortic arch atheroma, it is invasive and may be limited to patients with suspected embolism. Present post-hoc analysis evaluated the acute dual study data on mild stroke patients who had aortic arch atheroma proven by TEE and evaluate whether combined cilostazol and aspirin therapy might reduce the rate of stroke recurrence comparing aspirin therapy.
View Article and Find Full Text PDFImpact of antiplatelet and anticoagulant drugs on postoperative bleeding in reverse total shoulder arthroplasty.
J Shoulder Elbow Surg
October 2024
Department of Orthopaedic Surgery, Fukui General Hospital, Fukui, Japan. Electronic address:
Background: The decision to withdraw or continue antiplatelet and anticoagulant drugs would be balanced on the bleeding risk and the cardiovascular risk. The purpose of this study was to investigate perioperative bleeding in reverse shoulder arthroplasty (RSA) to determine the impact of oral antiplatelet and anticoagulant medications in the absence of drug withdrawal. The hypothesis was that the continuation of antiplatelet and anticoagulant drugs would increase postoperative bleeding but to a limited extent.
View Article and Find Full Text PDFUpdated Assessment of Practice Patterns of Perioperative Management of Antiplatelet and Anticoagulant Therapy in Interventional Pain Management.
Pain Physician
August 2024
Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Background: The role of antiplatelet/anticoagulant therapy is well known for its primary and secondary prevention of sequela from cardiovascular disease by decreasing the incidence of acute cerebral, cardiovascular, peripheral vascular, and other thrombo-embolicevents. The overwhelming data show that the risk of thrombotic events is significantly higher than that of bleeding during surgery after antiplatelet drug discontinuation. It has been assumed that discontinuing antiplatelet therapy prior to performing interventional pain management techniques is a common practice, even though doing so may potentially increase the risk of acute cerebral and cardiovascular events.
View Article and Find Full Text PDFIs it effective to initiate cilostazol-based dual antiplatelet therapy before achieving blood pressure control? Lessons from the CSPS study.
Hypertens Res
October 2024
The department of Geriatric and General Medicine, Osaka University graduate school of medicine, Osaka, Japan.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!