title: Ultra-Early Combination Antiplatelet Therapy with Cilostazol for the Prevention of Branch Atheromatous Disease: A Multicenter Prospective Study.
abstract: OBJECTIVE
  The optimal use of antiplatelet therapy for intracranial branch atheromatous disease (BAD) is not known.
  
  
  METHODS
  We conducted a prospective multicenter, single-group trial of 144 consecutive patients diagnosed with probable BAD. All patients were treated within 12 h of symptom onset to prevent clinical progression using dual antiplatelet therapy with cilostazol plus one oral antiplatelet drug (aspirin or clopidogrel). Endpoints of progressive BAD in the dual therapy group at 2 weeks were compared with a matched historical control group of 142 patients treated with single oral antiplatelet therapy using either cilostazol, aspirin, or clopidogrel.
  
  
  RESULTS
  Progressive motor paresis occurred in 14 patients (9.7%) in the aggressive antiplatelet group, compared with 48 (33.8%) in the matched single antiplatelet group. Multivariate logistic regression analysis revealed the following variables to be associated with a better prognosis for BAD: baseline modified Rankin Scale score, dual oral antiplatelet therapy with cilostazol, and dyslipidemia (odds ratios of 0.616, 0.445, and 0.297, respectively). Hypertension was associated with a worse prognosis for BAD (odds ratio of 1.955).
  
  
  CONCLUSIONS
  Our trial showed that clinical progression of BAD was significantly reduced with the administration of ultra-early aggressive combination therapy using cilostazol compared to treatment with antiplatelet monotherapy.
authors.affiliation: Departments of Stroke Medicine and Neurosurgery, Dohtoh Neurosurgery Hospital and Okhotsk Stroke Medical Center, Kitami City, Japan.
authors.forename: Teruo
authors.initials: T
authors.lastname: Kimura
authors.forename: Adam
authors.initials: A
authors.lastname: Tucker
authors.forename: Toshihide
authors.initials: T
authors.lastname: Sugimura
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Seki
authors.forename: Shin
authors.initials: S
authors.lastname: Fukuda
authors.forename: Satoru
authors.initials: S
authors.lastname: Takeuchi
authors.forename: Shiro
authors.initials: S
authors.lastname: Miyata
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Fujita
authors.forename: Akira
authors.initials: A
authors.lastname: Hashizume
authors.forename: Naoto
authors.initials: N
authors.lastname: Izumi
authors.forename: Kazutsune
authors.initials: K
authors.lastname: Kawasaki
authors.forename: Makoto
authors.initials: M
authors.lastname: Katsuno
authors.forename: Masaaki
authors.initials: M
authors.lastname: Hashimoto
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Sako
keywords: Branch atheromatous disease; Cilostazol; Dual antiplatelet therapy; Progressive stroke