Department of Neurology, the 2nd Affiliated Hospital of Guangzhou Medical College, Guangzhou, China.
Neurosci Bull. 2009 Dec;25(6):383-90. doi: 10.1007/s12264-009-6192-2.
To compare the effects of cilostazol on cerebral arteries and cerebrovascular blood flow in secondary prevention of ischemic stroke, with those of aspirin.
Sixty-eight patients who had ischemic stroke during the recent 1-6 months were recruited and randomized into cilostazol or aspirin group. Cerebrovascular condition was assessed by magnetic resonance angiography (MRA) and transcranial doppler ultrasonography (TCD) at the beginning of the study and after 12-month medication.
During the clinical follow-up, ischemic stroke recurred in 2 patients in cilostazol group, while in aspirin group, one case of ischemic stroke recurrence and one case of acute myocardial infarction were found. MRA revealed that in aspirin group, the percentages of patients experiencing aggravation and attenuation of cerebrovascular condition were 3.3% and 6.7%, respectively, while in aspirin group, they were 3.3% and 10%, respectively. Moreover, TCD revealed that 26.9% of the patients in aspirin group and 14.3% of the patients in cilostazol group experienced aggravation of cerebrovascular condition. However, the systolic peak flow velocity of the previously abnormal arteries increased by 42.9% after 12-month medication of cilostazol, which was significantly higher than that after aspirin medication (27.5%) (P = 0.04). Furthermore, as a major side effect of antiplatelet therapy, the frequency of bleeding was much less in cilostazol group (0 case in cilostazol group vs 5 in aspirin, P< 0.05).
Cilostazol is as effective as aspirin in preventing the aggravation of cerebral arteries in secondary prevention of ischemic stroke. Besides, it is more safe. Cilostazol can increase the systolic peak flow velocity of cerebral arteries, which may improve the blood supply of focal ischemia.
比较西洛他唑对缺血性脑卒中二级预防中脑动脉及脑血流的影响与阿司匹林的差异。
选择 68 例近 1~6 个月内发生缺血性脑卒中的患者，随机分为西洛他唑组和阿司匹林组。在研究开始和 12 个月药物治疗后，分别采用磁共振血管造影（MRA）和经颅多普勒超声（TCD）评估脑血管状况。
在临床随访期间，西洛他唑组有 2 例患者发生缺血性脑卒中复发，而阿司匹林组有 1 例缺血性脑卒中复发和 1 例急性心肌梗死。MRA 显示，阿司匹林组脑血管状况恶化和改善的患者比例分别为 3.3%和 6.7%，而西洛他唑组则分别为 3.3%和 10%。此外，TCD 显示，阿司匹林组有 26.9%的患者和西洛他唑组有 14.3%的患者出现脑血管状况恶化。然而，西洛他唑治疗 12 个月后，先前异常动脉的收缩期峰值流速增加了 42.9%，明显高于阿司匹林治疗组（27.5%）（P = 0.04）。此外，作为抗血小板治疗的主要副作用，西洛他唑组出血频率明显低于阿司匹林组（西洛他唑组 0 例，阿司匹林组 5 例，P<0.05）。
西洛他唑在预防缺血性脑卒中二级预防中脑动脉恶化方面与阿司匹林同样有效。此外，它更安全。西洛他唑可增加脑动脉的收缩期峰值流速，可能改善局灶性缺血的血液供应。
