Edinburgh Imaging

23 May 18. New trial for stroke - LACI-2

New trial researching drugs that may prevent cognitive decline and dementia after a stroke, commences today.

BHF LACI-2 trial to commence

 Professor Joanna Wardlaw is leading LACI-2, a British Heart Foundation (BHF) funded clinical trial to see if existing drugs, which work on pathways shown in our work above, prevent cognitive decline and dementia in patients with stroke due to small vessel disease (SVD).

The BHF and Alzheimer’s Society are working together to test two existing treatments for heart and circulatory diseases in people who have suffered a type of stroke that occurs in the smallest blood vessels in the brain – lacunar stroke affects around 35,000 people in the UK each year. The first stage results are presented at the Alzheimer’s Society Annual Conference today.

There are currently no proven treatments to prevent a lacunar stroke, and existing anti-clotting treatments for stroke including aspirin may even be harmful.

Alzheimer's Society LACI-1 results

Positive results from stage one of the Lacunar Intervention trial (LACI-1), funded by Alzheimer’s Society have allowed the second stage (LACI-2), funded by the British Heart Foundation, to be rolled out during Dementia Awareness Week.

LACI-1 found that it was safe for people who have had a lacunar stroke to take cilostazol and isosorbide mononitrate, and at what dose, worked out the best questions to ask participants in the trial, and allowed the research team to develop a useful database for all the trial records.

Due to this essential groundwork, LACI-2 can now be more quickly rolled out to include 400 people who have had lacunar strokes. Over three years, the team led by Professor Joanna Wardlaw at the University of Edinburgh will establish what effect these drugs have on reducing the risk of more lacunar strokes, and the risk of developing cognitive decline.


Having a stroke is scary, because you don’t know how it will affect you in the long run but, because so little is known about the best way to treat lacunar strokes, it was an extra level of concern for me and my family. I consider myself to be very lucky, I’ve come out of the other side with no speech or motor deficiencies. But I know that many people who have a lacunar stroke aren’t as fortunate as I’ve been, which is why this research is so close to my heart. These new treatments are a really exciting prospect.

Joseph Henerey, 67West Lothian, had a lacunar stroke two years ago and was enrolled on the LACI-1 trial


In LACI-2 patients will take cilostazol, isosorbide mononitrate or both. The researchers think that these drugs may help reduce the damage to the arteries in the brain that cause the stroke and lead to cognitive decline. They will perform MRI scans on people taking part in the trial to see what effects these drugs have on the small blood vessels within the brain.

If successful, this research could lead to new ways to treat lacunar strokes and prevent some cases of dementia.


Research into lacunar strokes has often fallen in to the ‘gap’ between stroke research and dementia research so it hasn’t always been easy to find funding. I’m thrilled to see two charities working together to fund our research so that we can bring benefits to people who have had a lacunar stroke, and are at risk of developing cognitive decline, as soon as possible.

Professor Joanna WardlawUniversity of Edinburgh

The Edinburgh team are collaborating with the University of Nottingham to deliver the trial and a number of other research groups including those from hospitals in Derby, Fife, Glasgow, Leeds and London amongst others.