Abstract 2803: Cilostazol Reduces Carotid Atherothrombotic Plaques In Patients With Acute Ischemic Stroke During A 6-month Follow-up
Introduction: We previously reported that patients treated with aspirin plus cilostazol during the acute phase of ischemic stroke had less neurological deterioration than those treated with aspirin alone. However, the mechanisms of this beneficial effect remain unknown. Although cilostazol has been reported to induce regression of carotid atherosclerosis in patients with type 2 diabetes mellitus, no report has focused on patients with acute ischemic stroke. Therefore, we performed carotid ultrasonography in a sub-study of a randomized trial to investigate the effects of aspirin plus cilostazol on the progression of carotid plaques and intima-media thickness (IMT) during the first 6 months after acute ischemic stroke.
Patients and Methods: This randomized study compared the effects of oral aspirin alone to aspirin plus cilostazol in patients admitted to our hospital due to non-cardioembolic ischemic stroke within 48 h of stroke onset. Maximum IMT within the internal and common carotid arteries (max IMT) and plaque score (PS) were examined on admission and 6 months after study entry. No other antithrombotic drugs were administered during the follow-up period. For statistical analysis, on-treatment analysis was conducted, and patients who had adverse effects due to aspirin or cilostazol and were treated with other antithrombotics due to neurological deterioration (NIH Stroke Scale score ≥1) were excluded from the analysis.
Results: Seventy-six patients were enrolled in the study and randomly allocated to one of the treatment groups. During the 6-month follow-up, 10 patients in the aspirin group and 3 in the aspirin plus cilostazol group experienced neurological deterioration. As a result, 16 patients in the aspirin group and 26 in the aspirin plus cilostazol group completed the 6-month follow-up. Vascular risk factors and use of antihypertensive or lipid-lowering drugs did not significantly differ between the groups. In the aspirin plus cilostazol group, the changes in max IMT had a tendency towards regression when compared with the aspirin group (-0.23 ± 0.60 vs. 0.10 ± 0.53; p = 0.08). The regression in PS was significantly greater in the aspirin plus cilostazol group than in the aspirin group (-1.02 ± 2.20 vs. 1.00 ± 2.27; p = 0.0068).
Conclusion: Compared to treatment with aspirin alone, treatment with aspirin plus cilostazol is more effective for preventing progression of carotid plaques for 6 months after stroke onset.
- © 2012 by American Heart Association, Inc.