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Long-Term Sequential Dual Antiplatelet Therapy Based on Cilostazol in Symptomatic Intracranial Arterial Stenosis (SPDACSIS-RCT)

8 november 2026 uppdaterad av: Second Affiliated Hospital of Soochow University

The Secondary Preventive Effect of Long-term Sequential Dual Antiplatelet Therapy Based on Cilostazol in Cerebral Infarction Patients With Symptomatic Moderate to Severe Intracranial Arterial Stenosis: A Single-Center, Randomized, Open-Label, Blinded-Endpoint Clinical Trial (SPDACSIS-RCT)

This study aims to evaluate whether long-term dual antiplatelet therapy (DAPT) with cilostazol reduces the risk of recurrent symptomatic ischemic stroke or all-cause mortality compared with single antiplatelet therapy (SAPT) in patients with symptomatic moderate-to-severe intracranial arterial stenosis, following the completion of standard DAPT.

Studieöversikt

Status

Rekrytering

Betingelser

Intervention / Behandling

Detaljerad beskrivning

Patients with symptomatic intracranial arterial stenosis remain at high risk of recurrent stroke despite standard medical treatment. Although short-term DAPT is recommended, the optimal long-term antiplatelet strategy following standard treatment remains uncertain. Cilostazol-based DAPT may provide additional protection against recurrent ischemic events with an acceptable bleeding risk. Therefore, this study aims to evaluate whether long-term cilostazol-based DAPT reduces the risk of recurrent symptomatic ischemic stroke or all-cause mortality compared to SAPT in patients with symptomatic moderate-to-severe intracranial arterial stenosis.

Studietyp

Interventionell

Inskrivning (Beräknad)

480

Fas

  • Fas 4

Kontakter och platser

Det här avsnittet innehåller kontaktuppgifter för dem som genomför studien och information om var denna studie genomförs.

Studiekontakt

Studieorter

  • Kina
    • Jiangsu
      • Suzhou, Jiangsu, Kina, 215004
        • Rekrytering
        • Second Affiliated Hospital of Soochow University
        • Kontakt:

Deltagandekriterier

Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.

Urvalskriterier

Åldrar som är berättigade till studier

18 år till 80 år (Vuxen, Äldre vuxen)

Tar emot friska volontärer

Nej

Kön som är behöriga för studier

Allt

Beskrivning

Inclusion Criteria:

  1. Age: 18-80 years old.
  2. Acute mild non-cardioembolic stroke.
  3. Ischemic stroke or transient ischemic attack (TIA) occurring 2 to 4 weeks prior to enrollment.
  4. NIHSS score ≤15 at enrollment and pre-stroke mRS score ≤2.
  5. Ischemic stroke or TIA attributable to the territory of the qualifying intracranial artery.
  6. Symptomatic 70%-99% intracranial atherosclerotic stenosis confirmed by DSA, CTA, or MRA.
  7. Completion of 3 months of standard dual antiplatelet therapy (DAPT).
  8. Medication adherence ≥80% during the 3 months of standard DAPT.
  9. High risk for recurrent stroke (defined by at least one prespecified high-risk feature) at the second screening after 3 months of standard DAPT.
  10. No intracranial endovascular or surgical revascularization within the preceding 3 months.
  11. No newly developed contraindications to cilostazol-based DAPT or single antiplatelet therapy.
  12. Signed informed consent by the patient or legally authorized representative.

Exclusion Criteria:

  1. High-risk cardioembolic source requiring or potentially requiring long-term anticoagulation, including persistent or paroxysmal atrial fibrillation, mechanical heart valve or severe valvular disease, intracardiac thrombus, recent myocardial infarction with significant wall-motion abnormality, or severe cardiomyopathy.
  2. Stroke or TIA caused by nonatherosclerotic disease, including moyamoya disease, vasculitis, arterial dissection, or other definite nonatherosclerotic causes.
  3. Known allergy or serious adverse reaction to cilostazol, aspirin, clopidogrel, ticagrelor, or other antiplatelet agents.
  4. Current or previous severe heart failure.
  5. Severe bleeding event within the previous 6 months, including spontaneous intracranial hemorrhage, major gastrointestinal bleeding, or other bleeding requiring blood transfusion.
  6. Significant bleeding tendency or coagulation abnormality.
  7. Medical condition requiring long-term oral anticoagulation.
  8. Active malignancy or other serious illness with a life expectancy of less than 1 year.
  9. Severe cognitive impairment or psychiatric illness that would prevent adherence to study treatment or long-term follow-up.

Studieplan

Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.

Hur är studien utformad?

Designdetaljer

  • Primärt syfte: Förebyggande
  • Tilldelning: Randomiserad
  • Interventionsmodell: Parallellt uppdrag
  • Maskning: Enda

Vapen och interventioner

Deltagargrupp / Arm
Intervention / Behandling
Experimentell: Cilostazol-Based Dual Antiplatelet Therapy

Participants will receive cilostazol 50 mg twice daily in combination with one antiplatelet agent: aspirin 100 mg once daily, clopidogrel 75 mg once daily, or ticagrelor 90 mg twice daily, for 12 months.
Läkemedel: Cilostazol

Cilostazol 50 mg twice daily for 12 months. Cilostazol is administered in the experimental arm in combination with one antiplatelet agent: aspirin, clopidogrel, or ticagrelor.

Läkemedel: Aspirin

Aspirin 100 mg once daily for 12 months. Aspirin may be administered in combination with cilostazol in the experimental arm or as single antiplatelet therapy in the active comparator arm.

Läkemedel: Clopidogrel

Clopidogrel 75 mg once daily for 12 months. Clopidogrel may be administered in combination with cilostazol in the experimental arm or as single antiplatelet therapy in the active comparator arm.

Läkemedel: Ticagrelor

Ticagrelor 90 mg twice daily for 12 months. Ticagrelor may be administered in combination with cilostazol in the experimental arm or as single antiplatelet therapy in the active comparator arm.
Aktiv komparator: Single Antiplatelet Therapy

Participants will receive single antiplatelet therapy with aspirin 100 mg once daily, clopidogrel 75 mg once daily, or ticagrelor 90 mg twice daily, for 12 months.
Läkemedel: Aspirin

Aspirin 100 mg once daily for 12 months. Aspirin may be administered in combination with cilostazol in the experimental arm or as single antiplatelet therapy in the active comparator arm.

Läkemedel: Clopidogrel

Clopidogrel 75 mg once daily for 12 months. Clopidogrel may be administered in combination with cilostazol in the experimental arm or as single antiplatelet therapy in the active comparator arm.

Läkemedel: Ticagrelor

Ticagrelor 90 mg twice daily for 12 months. Ticagrelor may be administered in combination with cilostazol in the experimental arm or as single antiplatelet therapy in the active comparator arm.

Vad mäter studien?

Primära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Time to First Recurrent Symptomatic Ischemic Stroke or All-Cause Death
Tidsram: From randomization through 12 months

Time from Day 90 randomization to the first occurrence of recurrent symptomatic ischemic stroke or death from any cause.
From randomization through 12 months

Sekundära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Incidence of Any Stroke
Tidsram: 12 months

Occurrence of any ischemic or hemorrhagic stroke during follow-up.
12 months
Incidence of Hemorrhagic Stroke
Tidsram: 12 months

Occurrence of symptomatic intracranial hemorrhage or subarachnoid hemorrhage.
12 months
Incidence of Ischemic Stroke or Transient Ischemic Attack
Tidsram: Time Frame

Occurrence of ischemic stroke or transient ischemic attack during follow-up.
Time Frame
Modified Rankin Scale Score
Tidsram: 12 months

Functional outcome assessed using the Modified Rankin Scale (mRS), ranging from 0 to 6. A score of 0 indicates no symptoms, whereas a score of 6 indicates death. Higher scores represent greater disability and worse functional outcomes.(0 = no symptoms; 1 = no significant disability despite symptoms; 2 = slight disability, unable to perform all previous activities but able to manage personal affairs without assistance; 3 = moderate disability, requiring some help but able to walk without assistance; 4 = moderately severe disability, unable to walk without assistance and unable to attend to bodily needs without assistance; 5 = severe disability, bedridden, incontinent, and requiring constant nursing care and attention; and 6 = death.)
12 months
Incidence of All Vascular Events
Tidsram: 12 months

Composite vascular events including stroke, myocardial infarction, and other vascular events such as aortic dissection, aortic rupture, pulmonary embolism, hospitalization for heart failure, angina or peripheral artery disease, and coronary, aortic, cervicocephalic, or peripheral arterial revascularization.
12 months

Andra resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Major Bleeding
Tidsram: 12 months

Number and proportion of participants who experience bleeding classified as Bleeding Academic Research Consortium (BARC) grade 3 or higher during follow-up.
12 months
Incidence of Adverse Events
Tidsram: 12 months

Occurrence of any adverse event during the 12-month treatment and follow-up period.
12 months
Incidence of Cilostazol-Related Adverse Events Leading to Treatment Discontinuation
Tidsram: 12 months

Number and proportion of participants in the cilostazol-based dual antiplatelet therapy group who discontinue cilostazol because of cilostazol-related adverse events, including headache, diarrhea, abnormal stools, palpitations, tachycardia, dizziness, or other adverse reactions considered related to cilostazol.
12 months

Samarbetspartners och utredare

Det är här du hittar personer och organisationer som är involverade i denna studie.

Sponsor

Second Affiliated Hospital of Soochow University

Studieavstämningsdatum

Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.

Studera stora datum

Studiestart (Faktisk)

21 mars 2026

Primärt slutförande (Beräknad)

28 februari 2029

Avslutad studie (Beräknad)

30 juni 2029

Studieregistreringsdatum

Först inskickad

2 november 2026

Först inskickad som uppfyllde QC-kriterierna

8 november 2026

Första postat (Faktisk)

12 november 2026

Uppdateringar av studier

Senaste uppdatering publicerad (Faktisk)

12 november 2026

Senaste inskickade uppdateringen som uppfyllde QC-kriterierna

8 november 2026

Senast verifierad

1 november 2026

Mer information

Termer relaterade till denna studie

Nyckelord

Ytterligare relevanta MeSH-villkor

Andra studie-ID-nummer

  • LK2026004
  • SYW2026005 (Annat bidrag/finansieringsnummer: SuZhou Municipal Health Commission)

Plan för individuella deltagardata (IPD)

Planerar du att dela individuella deltagardata (IPD)?

NEJ

Läkemedels- och apparatinformation, studiedokument

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Nej

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Nej

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