A Comparison Study of Cilostazol and Aspirin on Changes in Volume of Cerebral Small Vessel Disease White Matter Changes: Protocol of a Multicenter, Randomized Controlled Trial

Han, Hyun Jeong; Kim, Byeong C.; Youn, Young Chul; Jeong, Jee Hyang; Lee, Jae Hong; Park, Kee Hyung; Park, Kyung Won; Kim, Eun-Joo; Oh, Mi Sun; Shim, Yong S.; Park, Hyun-Young; Yoon, Bora; Yoon, Soo Jin; Cho, Soo-Jin; Park, Key Chung; Na, Duk L.; Park, Sun Ah; Lee, Jongmin; Choi, Seong Hye

doi:10.12779/dnd.2019.18.4.138

Cited by 5 publications

(7 citation statements)

References 45 publications

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“…CSVD is characterized by progressive cerebral white matter changes due to chronic low perfusion and loss of autoregulation ( Han et al, 2019 ). In the current study, voxel-wise comparisons of gray and white matter volumes demonstrated less gray matter volume alterations, but more white matter volume reductions in CSVD, which was consistent with the previous consensus that CSVD was associated with white matter abnormalities ( Liu et al, 2020 , Wang et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Perfusion heterogeneity of cerebral small vessel disease revealed via arterial spin labeling MRI and machine learning

Wang

et al. 2022

NeuroImage: Clinical

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Section: Discussionmentioning

confidence: 99%

Perfusion heterogeneity of cerebral small vessel disease revealed via arterial spin labeling MRI and machine learning

Wang

et al. 2022

NeuroImage: Clinical

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“…A study in South Korea compares aspirin vs cilostazol in 254 patients with moderate or severe cerebral white matter changes and 1 or more lacunar infarction(s) on MRI, NCT 01932203 with a primary outcome of change in WMH volume between baseline and 104 weeks on MRI With secondary clinical outcomes (ischaemic strokes, all vascular events, cognition, and disability). 80 An ASPREE substudy (ENVIS-ion) described in 2012, will examine cognitive function and brain MRI at baseline and after 3 years of treatment in 600 subjects aged 70 years or older randomized to aspirin or placebo, NCT01038583. 81 Another ASPREE substudy, the Study of Neuro-cognitive Outcomes, Radiological and Retinal Effects of Aspirin in Sleep Apnoea (SNORE-ASA), assesses cognition, brain MRI and retinal changes in 296 subjects at study entry and after 3 years.…”

Section: Primary Preventionmentioning

confidence: 99%

Section: Additional Informationmentioning

confidence: 99%

ESO Guideline on covert cerebral small vessel disease

Wardlaw

Debette

Jokinen

et al. 2021

European Stroke Journal

108

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‘Covert’ cerebral small vessel disease (ccSVD) is common on neuroimaging in persons without overt neurological manifestations, and increases the risk of future stroke, cognitive impairment, dependency, and death. These European Stroke Organisation (ESO) guidelines provide evidence-based recommendations to assist with clinical decisions about management of ccSVD, specifically white matter hyperintensities and lacunes, to prevent adverse clinical outcomes. The guidelines were developed according to ESO standard operating procedures and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. We prioritised the clinical outcomes of stroke, cognitive decline or dementia, dependency, death, mobility and mood disorders, and interventions of blood pressure lowering, antiplatelet drugs, lipid lowering, lifestyle modifications, glucose lowering and conventional treatments for dementia. We systematically reviewed the literature, assessed the evidence, formulated evidence-based recommendations where feasible, and expert consensus statements. We found little direct evidence, mostly of low quality. We recommend patients with ccSVD and hypertension to have their blood pressure well controlled; lower blood pressure targets may reduce ccSVD progression. We do not recommend antiplatelet drugs such as aspirin in ccSVD. We found little evidence on lipid lowering in ccSVD. Smoking cessation is a health priority. We recommend regular exercise which may benefit cognition, and a healthy diet, good sleep habits, avoiding obesity and stress for general health reasons. In ccSVD, we found no evidence for glucose control in the absence of diabetes or for conventional Alzheimer dementia treatments. Randomised controlled trials with clinical endpoints are a priority for ccSVD.

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“…Antiplatelets inhibit thrombus formation and reduce the blood flow to different regions of the brain, potentially reducing the severity of cognitive impairment. Certain drugs like cilostazol have vasodilatory effects and protective effects on the endothelium in addition to their antiplatelet effect; therefore, some VD patients may benefit from their use [ 55 ]. A recent clinical trial supported this, reporting a decreased risk of repeated stroke when treated with cilostazol, especially hemorrhagic stroke [ 56 ].…”

Section: Discussionmentioning

confidence: 99%

Antiplatelets and Vascular Dementia: A Systematic Review

Alexander

Visagan

Jawhar

et al. 2022

Journal of Aging Research

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Vascular dementia (VD) is a neurocognitive disorder whose precise definition is still up for debate. VD generally refers to dementia that is primarily caused by cerebrovascular disease or impaired cerebral blood flow. It is a subset of vascular cognitive impairment, a class of diseases that relate any cerebrovascular injury as a causal or correlating factor for cognitive decline, most commonly seen in the elderly. Patients who present with both cognitive impairment and clinical or radiologic indications of cerebrovascular pathology should have vascular risk factors, particularly hypertension, examined and treated. While these strategies may be more effective at avoiding dementia than at ameliorating it, there is a compelling case for intensive secondary stroke prevention in these patients. Repeated stroke is related to an increased chance of cognitive decline, and poststroke dementia is connected with an increased risk of death. In general, most physicians follow recommendations for secondary stroke prevention in patients with VD, which can be accomplished by the use of antithrombotic medicines such as antiplatelets (aspirin, clopidogrel, ticlopidine, cilostazol, etc.). In individuals with a high risk of atherosclerosis and those with documented symptomatic cerebrovascular illness, antiplatelets treatment lowers the risk of stroke. While this therapy strategy of prevention and rigorous risk management has a compelling justification, there is only limited and indirect data to support it. The following systematic review examines the role of antiplatelets in the management of vascular dementia in published clinical trials and studies and comments on the current evidence available to support their use and highlights the need for further study.

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A Comparison Study of Cilostazol and Aspirin on Changes in Volume of Cerebral Small Vessel Disease White Matter Changes: Protocol of a Multicenter, Randomized Controlled Trial

Cited by 5 publications

References 45 publications

Perfusion heterogeneity of cerebral small vessel disease revealed via arterial spin labeling MRI and machine learning

Perfusion heterogeneity of cerebral small vessel disease revealed via arterial spin labeling MRI and machine learning

ESO Guideline on covert cerebral small vessel disease

Antiplatelets and Vascular Dementia: A Systematic Review

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