Brain Research Imaging Centre, Centre for Clinical Brain Sciences, UK Dementia Institute Centre at the University of Edinburgh, United Kingdom (G.W.B., M.S.S., M.J.T., F.C., Y.S., I.H., F.N.D., J.M.W.).
Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands (E.J.).
Stroke. 2022 Jan;53(1):29-33. doi: 10.1161/STROKEAHA.121.034866. Epub 2021 Dec 1.
Cerebral small vessel disease-a major cause of stroke and dementia-is associated with cerebrovascular dysfunction. We investigated whether short-term isosorbide mononitrate (ISMN) and cilostazol, alone or in combination, improved magnetic resonance imaging-measured cerebrovascular function in patients with lacunar ischemic stroke.
Participants were randomized to ISMN alone, cilostazol alone, both ISMN and cilostazol, or no medication. Participants underwent structural, cerebrovascular reactivity (to 6% carbon dioxide) and phase-contrast pulsatility magnetic resonance imaging at baseline and after 8 weeks of medication.
Of 27 participants (mean age, 68±7.7; 44% female), 22 completed cerebrovascular reactivity and pulsatility imaging with complete datasets. White matter cerebrovascular reactivity increased in the ISMN (β=0.021%/mm Hg [95% CI, 0.003-0.040]) and cilostazol (β=0.035%/mm Hg [95% CI, 0.014-0.056]) monotherapy groups and in those taking any versus no medication (β=0.021%/mm Hg [95% CI, 0.005-0.037]).
While limited by small sample size, we demonstrate that measuring cerebrovascular function with magnetic resonance imaging is feasible in clinical trials and that ISMN and cilostazol may improve cerebrovascular function. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02481323. URL: www.isrctn.com; Unique identifier: ISRCTN12580546. URL: www.clinicaltrialsregister.eu; Unique identifier: EudraCT 2015-001953-33.
脑小血管病是中风和痴呆的主要病因，与脑血管功能障碍有关。我们研究了短期单硝酸异山梨酯（ISMN）和西洛他唑单独或联合应用是否能改善腔隙性缺血性卒中患者的磁共振成像测量的脑血管功能。
参与者被随机分配到 ISMN 单药组、西洛他唑单药组、ISMN 和西洛他唑联合用药组或无药物治疗组。参与者在基线和 8 周药物治疗后接受了结构磁共振成像、脑血管反应性（6%二氧化碳）和相位对比搏动性磁共振成像检查。
在 27 名参与者（平均年龄 68±7.7 岁，44%为女性）中，有 22 名完成了脑血管反应性和搏动性成像检查，且数据完整。ISMN（β=0.021%/mmHg[95%CI，0.003-0.040]）和西洛他唑（β=0.035%/mmHg[95%CI，0.014-0.056]）单药治疗组以及任何药物治疗组与无药物治疗组相比，白质脑血管反应性均增加（β=0.021%/mmHg[95%CI，0.005-0.037]）。
尽管样本量较小，但我们证明了使用磁共振成像测量脑血管功能在临床试验中是可行的，并且 ISMN 和西洛他唑可能改善脑血管功能。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT02481323。网址：www.isrctn.com；唯一标识符：ISRCTN12580546。网址：www.clinicaltrialsregister.eu；唯一标识符：EudraCT 2015-001953-33。
