Edinburgh Imaging

24 Apr 19. New Stroke Drug

Drugs such as such as cilostazol and isosorbide mononitrate, could be used to prevent stroke and dementia.

Stroke and dementia are two of the largest health problems facing the ageing populations in modern societies.

Damage to small blood vessels in the brain is responsible for around a quarter of strokes. It is also a common cause of memory problems and dementia.

About 400,000 people in the UK are affected by small vessel disease but there are no specific treatments at present.


We need to repair the lining of the blood vessels in the brain.

The problem appears to be that the lining of the small blood vessels stops working properly so stops protecting the brain or being able to supply enough oxygen and nutrients to the brain.

Some drugs that are widely used to stop damage to the small blood vessels in the legs or heart in the UK, or to prevent stroke or dementia in some Asia-Pacific countries, such as cilostazol and isosorbide mononitrate, might help slow the damage or even help repair the lining of the blood vessels in the brain. However, these drugs have not been tested directly in lacunar stroke in the UK – we do not know if patients will be able to take the drugs in addition to their usual medication.


The LACI-1 trial

The LACunar Intervention (LACI-1 )trial was funded by the Alzheimer’s Society and run by stroke researchers and clinical trials teams in Edinburgh and Nottingham.

It aimed to work out the best way to start the drugs, whether they could be taken together or not, if there were any risks of bleeding or falls or other problems, and if there was any sign of improvement in blood vessel function in the short term to suggest possible benefits if the drugs were taken long term.  

LACI-1 recruited 57 participants in a year, who took various combinations of the drugs for up to 9 weeks, did questionnaires, had lots of blood pressure measurements, measurement of blood clotting, measurements of function of blood vessels in the arm and (by using fancy brain scanning in Edinburgh) in the brain as well.


The results

LACI-1 showed that the drugs, Cilostazol and isosorbide mononitrate, were well tolerated when taken individually or together, in addition to conventional secondary stroke prevention.

It also showed that the drugs may improve blood vessel function in the arms and brain, as well as thinking speed, and possibly reduce abnormalities in the brain seen on brain scanning that indicate the effects of small blood vessel damage on the brain.

Therefore LACI-1 supports more testing of cilostazol and isosorbide mononitrate in a larger where patients can take the tablets for much longer to test the tablets’ ability to prevent worsening of brain damage, stroke, cognitive decline and dementia.


The future

The LACI-2 trial is now running in 25 hospitals in the UK, led by doctors and clinical trial experts in Edinburgh and Nottingham, funded by the British Heart Foundation.