title: Effects of cilostazol on the progression and regression of symptomatic intracranial artery stenosis: it reduces the risk of ischemic stroke.
abstract: OBJECTIVE
  To assess the efficacy and safety of cilostazol on the progression and regression of symptomatic intracranial artery stenosis.
  We searched the main databases for eligible trials including Medline (from 1966 to June 2014), Embase (from 1980 to June 2014), Cochrane Library (Issue 6, 2014), Chinese National Knowledge Infrastructure (from 1995 to June 2014), Current Controlled Trials (http://controlled-trials.com), Clinical Trials.gov (http://clinicaltrials.gov), and Chinese Clinical Trial Registry (http://www.chictr.org). All studies regarding prevention and treatment of symptomatic intracranial arterial stenosis by cilostazol were collected. The Mesh or text keywords were the English words: "cilostazol, phosphodiesterase 3 inhibitor, atherosclerosis, and ischemic stroke." No restrictions were put on publications or publication language.
  
  
  METHODS
  Grade A or B randomized controlled trials were selected according to the quality of evaluation criteria from the Cochrane Collaboration, in which cilostazol and aspirin were used to evaluate the effects of cilostazol in the treatment of patients with symptomatic intracranial artery stenosis. The quality of study methodology was evaluated based on criteria described in Cochrane Reviewer's Handbook 5.0.1. RevMan 5.2 software was used for data analysis.
  
  
  METHODS
  Clinical efficacy and safety of cilostazol in stopping progression and promoting regression of symptomatic intracranial artery stenosis were measured by magnetic resonance angiography and transcranial Doppler.
  
  
  RESULTS
  Two randomized controlled trials with a total of 203 patients were included in this study. The results showed that while cilostazol was associated with a significantly reduced progression of intracranial artery stenosis (OR = 0.21, 95%CI: 0.09-0.47, P < 0.01), it had no beneficial effect on symptom regression (OR = 1.42, 95%CI: 0.80-2.51, P = 0.24). During the follow-up period, although some adverse effects developed, including headache, gastrointestinal disturbance, and dizziness, incidences of bleeding were lower than in aspirin-treated patients.
  
  
  CONCLUSIONS
  Cilostazol may prevent the progression of symptomatic intracranial artery stenosis, which could reduce the incidence of ischemic stroke.
authors.affiliation: Department of Neurology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.
authors.forename: Wen-Hui
authors.initials: WH
authors.lastname: Zhang
authors.affiliation: Department of Neurology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.
authors.forename: Fang-Fang
authors.initials: FF
authors.lastname: Cai
authors.affiliation: Department of Neurology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.
authors.forename: Zhong-Min
authors.initials: ZM
authors.lastname: Wen
keywords: aspirin; atherosclerosis; cilostazol; follow-up studies; intracranial artery stenosis; magnetic resonance angiography; nerve regeneration; neural regeneration; stroke, ischemic; systemic review; transcranial Doppler