The effect of cilostazol on carotid intima-media thickness progression in patients with symptomatic intracranial atherosclerotic stenosis
Bum Joon Kim, Joung-Ho Rha, Seong Rae Kim, Dong-Eog Kim, Hahn Young Kim, Ju-Hun Lee, Hee-Joon Bae, Moon-Ku Han, Dong-Wha Kang, Disya Ratanakorn, Jong S Kim, Sun U Kwon, Bum Joon Kim, Joung-Ho Rha, Seong Rae Kim, Dong-Eog Kim, Hahn Young Kim, Ju-Hun Lee, Hee-Joon Bae, Moon-Ku Han, Dong-Wha Kang, Disya Ratanakorn, Jong S Kim, Sun U Kwon
Abstract
Background: The progression of carotid intima-media thickness (CIMT) is closely associated with ischemic stroke recurrence. However, the efficacy of cilostazol on preventing CIMT progression in stroke patients has never been investigated properly by a prospective trial.
Methods: This study is a part of "Trial of Cilostazol in Symptomatic Intracranial Arterial Stenosis-2." Six centers that are available to measure CIMT according to the protocol participated in this substudy. After 7 months of randomization, the changes of CIMT were compared between cilostazol group and clopidogrel group. CIMT was measured by a semiautomated software (Intimascope) and was presented as the mean of maximum (CIMT-max) and average (CIMT-ave) of both common carotid arteries. Linear logistic regression analysis and analysis of covariance were performed to verify the independent factors associated with CIMT progression.
Results: Among the 85 patients, 39 subjects were assigned to cilostazol group and 46 subjects to clopidogrel group. Follow-up CIMT significantly decreased in cilostazol group (CIMT-max: -.03 ± .11 and CIMT-ave: -.02 ± .08) compared with the increase in clopidogrel group (CIMT-max: .04 ± .20 and CIMT-ave: .04 ± .11; P = .05 and P = .04, respectively). Female, diabetes, and smoking were independently associated with the progression of CIMT, whereas the use of cilostazol was against CIMT progression from the results of linear regression analysis (P = .03 for both CIMT-max and CIMT-ave). The use of cilostazol also well predicted less progression of CIMT at follow-up after adjusting for baseline CIMT values and conventional risk factors (CIMT-max: P = .04 and CIMT-ave: P = .03).
Conclusion: Cilostazol has a beneficial effect in preventing the progression of CIMT in ischemic stroke patients.
Trial registration: ClinicalTrials.gov NCT00130039.
Keywords: Intracranial arterial stenosis; antiplatelets; atherosclerosis; intima–media thickness.
Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.
Source: PubMed