European Neurology
Original Paper
Effect of Cilostazol in the Treatment of Acute Ischemic Stroke in the Lenticulostriate Artery TerritoryKondo R.a · Matsumoto Y.a · Furui E.b · Itabashi R.b · Sato S.b · Yazawa Y.b · Shimizu H.c · Fujiwara S.c · Takahashi A.d · Tominaga T.eDepartments of aNeuroendovascular Therapy, bStroke Neurology, and cNeurosurgery, Kohnan Hospital, and Departments of dNeuroendovascular Therapy, and eNeurosurgery, Tohoku University, Sendai, Japan
|
|
Log in to MyKarger to check if you already have access to this content.
KAB
Buy a Karger Article Bundle (KAB) and profit from a discount!
If you would like to redeem your KAB credit, please log in.
Save over 20% compared to the individual article price.
Article / Publication Details
Received: February 03, 2012
Accepted: September 07, 2012
Published online: November 29, 2012
Issue release date: February 2013
Number of Print Pages: 7
Number of Figures: 4
Number of Tables: 5
ISSN: 0014-3022 (Print)
eISSN: 1421-9913 (Online)
For additional information: https://www.karger.com/ENE
Abstract
Background: Cilostazol, an inhibitor of phosphodiesterase 3, has various pleiotropic effects besides its antiplatelet activity. This study examined the efficacy of cilostazol for the treatment of acute perforating artery infarction. Methods: In this prospective, randomized, open-label, blinded-end point trial, 100 patients with cerebral infarction in the territory of the lenticulostriate arteries were enrolled within 48 h of onset. Patients were randomly treated with both cilostazol and ozagrel for 14 days (n = 50, cilostazol group) or ozagrel alone for 14 days (n = 50, control group). The primary end point was the proportion of favorable outcomes 30 days after randomization as defined by a modified Rankin Scale (mRS) score of 0–2. Secondary end points included the incidence of neurological deterioration (an increase of ≥2 on the National Institutes of Health Stroke Scale within 7 days). Results: Favorable outcomes (mRS scores 0–2) were similar in both groups (81.3 and 82.0% in the cilostazol and control groups, respectively). The incidence of neurological deterioration was lower in the cilostazol group than the control group (12.5 and 16.0%, respectively) with a 21.9% relative risk reduction, although the difference was not statistically significant. Conclusions: Cilostazol did not prevent the neurological deterioration of perforating artery infarction.
© 2012 S. Karger AG, Basel
Related Articles:
References
- Turin TC, Kita Y, Rumana N, Nakamura Y, Takashima N, Ichikawa M, Sugihara H, Morita Y, Hirose K, Okayama A, Miura K, Ueshima H: Ischemic stroke subtypes in a Japanese population: Takashima Stroke Registry, 1988–2004. Stroke 2010;41:1871–1876.
- Kim YB, Moon HS, Suh BC, Park KY, Lee YT, Chung PW: Topographic patterns and stroke subtypes according to progressive motor deficits in lacunar syndrome. J Stroke Cerebrovasc Dis 2011;20:352–356.
- Ohara T, Yamamoto Y, Tamura A, Ishii R, Murai T: The infarct location predicts progressive motor deficits in patients with acute lacunar infarction in the lenticulostriate artery territory. J Neurol Sci 2010;293:87–91.
- Rödén-Jüllig Å, Britton M, Malmkvist K, Leijd B: Aspirin in the prevention of progressing stroke: a randomized controlled trial. J Intern Med 2003;254:584–590.
- Rödén-Jüllig Å, Britton M: Effectiveness of heparin treatment for progressing ischemic stroke: before and after study. J Intern Med 2000;248:287–291.
- Kambayashi J, Liu Y, Sun B, Shakur Y, Yoshitake M, Czerwiec F: Cilostazol as a unique antithrombotic agent. Curr Pharm Des 2003;9:2289–2302.
- Nakamura K, Ikomi F, Ohhashi T: Cilostazol, an inhibitor of type 3 phosphodiesterase, produce endothelium-independent vasodilation in pressurized rabbit cerebral penetrating arterioles. J Vasc Res 2006;43:86–94.
- Matsumoto T, Noguchi E, Ishida K, Nakayama N, Kobayashi T, Kamata K: Cilostazol improves endothelial dysfunction by increasing endothelium-derived hyperpolarizing factor response in mesenteric arteries from type 2 diabetic rats. Eur J Pharmacol 2008;599:102–109.
- Lee YS, Bae HJ, Kang DW, Lee SH, Yu K, Park JM, Cho YJ, Hong KS, Kim DE, Kwon SU, Lee KB, Rha JH, Koo J, Han MG, Lee SJ, Lee JH, Jung SW, Lee BC, Kim JS: Cilostazol in acute ischemic stroke treatment (CAIST Trial): a randomized double-blind non-inferior trial. Cerebrovasc Dis 2011;32:65–71.
-
Gotoh F, Tohgi H, Hirai S, Terashi A, Fukuuchi Y, Otomo E, Shinohara Y, Itoh E, Masuda T, Sawada T, Yamaguchi T, Nishimura K, Ohashi Y: Cilostazol Stroke Prevention Study: a placebo-controlled double-blind trial for secondary prevention of cerebral infarction. J Stroke Cerebrovasc Dis 2000;9:147–157.
External Resources
- Shinohara Y, Katayama Y, Uchiyama S, Yamaguchi T, Harada S, Matsuoka K, Ohashi Y, Tanahashi N, Yamamoto H, Genka C, Kitagawa Y, Kusuoka H, Nishimaru K, Tsushima M, Koretsune Y, Sawada T, Hamada C for the CSPS 2 group: Cilostazol for prevention of secondary stroke (CSPS 2): an aspirin-controlled, double-blind, randomised non-inferior trial. Lancet Neurol 2010;9:959–968.
-
Lasjaunias P, Berenstein A, ter Brugge KG: The middle cerebral artery; in Lasjaunias P, Berenstein A, ter Brugge KG (eds): Surgical Neuroangiography, ed 2. Berlin, Springer, 2001, vol 1, pp 613–614. Pullicino P: Lenticulostriate arteries; in Bogousslavsky J, Caplan L (eds): Stroke Syndromes, ed 2. Cambridge, Cambridge University Press, 2001, pp 428–438.
- Oishi M, Mochizuki Y, Hara M, Yoshihashi H, Takasu T: Effects of sodium ozagrel on hemostatic markers and cerebral blood flow in lacunar infarction. Clin Neuropharmacol 1996;19:526–531.
- Fisher CM: Lacunar strokes and infarcts: a review. Neurology 1982;32:871–876.
- Fisher CM: The arterial lesions underlying lacunes. Acta Neuropathol 1968;12:1–15.
- Caplan LR: Intracranial branch atheromatous disease: a neglected, understudied, and underused concept. Neurology 1989;39:1246–1250.
- Yamamoto Y, Ohara T, Hamanaka M, Hosomi A, Tamura A, Akiguchi T: Characteristics of intracranial branch atheromatous disease and its association with progressive motor deficits. J Neurol Sci 2011;304:78–82.
- Lee KB, Oh HG, Roh H, Ahn MY: Can we discriminate stroke mechanisms by analyzing the infarct patterns in the striatocapsular region? Eur Neurol 2008;60:79–84.
- Fisher CM: Capsular infarcts: the underlying vascular lesions. Arch Neurol 1979;36:65–73.
- Fisher CM, Caplan LR: Basilar artery branch occlusion: a case of pontine infarction. Neurology 1971;21:900–905.
- Wardlaw JM, Sandercock PAG, Dennis MS, Starr J: Is breakdown of the blood-brain barrier responsible for lacunar stroke, leukoaraiosis, and dementia? Stroke 2003;34:806–812.
- Fernando MS, Simpson JE, Matthews F, Brayne C, Lewis CE, Barber R, Kalaria RN, Forster G, Esteves F, Wharton SB, Shaw PJ, O’Brien JT, Ince PG: White matter lesions in an unselected cohort of the elderly: molecular pathology suggests origin from chronic hypoperfusion injury. Stroke 2006;37:1391–1398.
- Wardlaw JM, Doubal F, Armitage P, Chappell F, Carpenter T, Muñoz Maniega S, Farrall A, Sudlow C, Dennis M, Dhillon B: Lacunar stroke is associated with diffuse blood-brain barrier dysfunction. Ann Neurol 2009;65:194–202.
- Topakian R, Barrick TR, Howe FA, Markus HS: Blood-brain barrier permeability is increased in normal appearing white matter in patients with lacunar stroke and leukoaraiosis. J Neurol Neurosurg Psychiatry 2010;81:192–197.
- Ma KC, Olsson Y: Structural and vascular permeability abnormalities with lacunes of human brain. Ann Neurol Scand 1993;88:100–107.
- Wardlaw JM, Dennis MS, Warlow CP, Sandercock PA: Imaging appearance of the symptomatic perforating artery in patients with lacunar infarction: occlusion or other vascular pathology? Ann Neurol 2001;50:208–215.
- Lugnier C: Cyclic nucleotide phosphodiesterase (PDE) superfamily: a new target for the development of specific therapeutic agents. Pharmacol Ther 2006;109:366–398.
- Torii H, Kubota H, Ishihara H, Suzuki M: Cilostazol inhibits the redistribution of the actin cytoskeleton and junctional proteins on the blood-brain barrier under hypoxia/reoxygenation. Pharmacol Res 2007;55:104–110.
- Yamamoto Y, Ohara T, Ishii R, Tanaka E, Murai T, Morii F, Tamura A, Ohara R: A combined treatment for acute larger lacunar-type infarction. J Stroke Cerebrovasc Dis 2011;20:387–394.
-
Otomo E, Kutsuzawa T, Kogure K, Hirai S, Goto F, Terashi A Takazaki A, Tazaki Y, Araki G, Ito E, Fujishima M, Nakashima M: Clinical usefulness of OKY-046 on the acute stage of cerebral thrombosis: double-blind trial in comparison with placebo (in Japanese with English abstract). J Clin Therapeut Med 1991;7:353–388.
- Shinohara Y, Yamaguchi T: Outline of the Japanese guidelines for the management of stroke 2004 and subsequent revision. Int J Stroke 2008;3:55–62.
Article / Publication Details
Received: February 03, 2012
Accepted: September 07, 2012
Published online: November 29, 2012
Issue release date: February 2013
Number of Print Pages: 7
Number of Figures: 4
Number of Tables: 5
ISSN: 0014-3022 (Print)
eISSN: 1421-9913 (Online)
For additional information: https://www.karger.com/ENE
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
Get Permission
PubMed ID
