title: The effect of acute medication with cilostazol, an anti-platelet drug, on the outcome of small vessel brain infarction.
abstract: Our objective was to investigate the effect of cilostazol in acute therapy for small vessel stroke patients. The neurologic deficits in some patients of small vessel brain infarction will progress even if a patient takes immediate medical treatments including aspirin or other antiplatelet drugs. In Japan, cilostazol, presenting not only the antiplatelet effect but also the arteriole dilation, is used for treatment of ischemic stroke. In this study, acute stroke patients with small vessel occlusion were treated with cilostazol instead of aspirin in the conventional medication after 2010. Therefore, patients between April 2007 and March 2009 were classified into the conventional group (group-con, n=220), and patients between April 2010 and March 2012 were classified into the cilostazol group (group-cilo, n=230). Enrolled patients were classified into lacunar infarction (LI) and branch atheromatous disease. Progressing stroke was defined as the increase of National Institutes of Health Stroke Scale score of 2 or more within 48 hours. The clinical outcome was assessed by the modified Rankin Scale (mRS) score at 1 month. As the result, the significant reduction in progressing stroke was dominant in the LI of brainstem (P=.01). The length of hospital stay was significantly shorter in the group-cilo compared with the group-con (18.6 and 21.2 days, P=.03). Moreover, mRS score at 1 month was significantly lower in the group-cilo than the group-con (1.9 and 2.3, P=.03). In conclusion, cilostazol reduced the risk of early neurologic deterioration of patients with small vessel brain infarction. It is eagerly desired to conduct a large randomized control trial.
authors: Department of Stroke Science, Research Institute for Brain and Blood Vessels-Akita, Akita, Japan. Electronic address: nakase@akita-noken.jp.
authors: Taizen
authors: T
authors: Nakase
authors: Department of Stroke Science, Research Institute for Brain and Blood Vessels-Akita, Akita, Japan.
authors: Masahiro
authors: M
authors: Sasaki
authors: Department of Stroke Science, Research Institute for Brain and Blood Vessels-Akita, Akita, Japan.
authors: Akifumi
authors: A
authors: Suzuki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020520:Brain Infarction / Q000188:drug therapy*; D000077407:Cilostazol; D018450:Disease Progression; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D020521:Stroke / Q000188:drug therapy*; D013777:Tetrazoles / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D000077407:Cilostazol
keywords: Antiplatelet medication; acute brain infarction; outcome; progressing stroke; small vessel occlusion