Medication Combination Safe, Improves Outcomes Following Lacunar Stroke

According to results presented at the International Stroke Conference 2023, cilostazol and isosorbide mononitrate are safe, well-tolerated, and effective medications for patients who experienced lacunar stroke. Participants who took both medications experienced potential benefits including reduction in cognitive impairment, and an increased quality of life after 1 year.  A phase III trial will continue to investigate the medication combination as potential treatment to prevent recurrent strokes in those who have experienced small blood vessel strokes.

The LACunar Intervention Trial 2 (LACI-2, NCT03451591), is an investigator-initiated, prospective, randomized, open-label, blinded endpoint phase II trial. In total, 363 adults from 26 stroke centers in the United Kingdom were included. Participants in the first cohort took 40-60 mg/day of isosorbide mononitrate by mouth, while the second cohort took 200 mg/day of cilostazol by mouth. For the third cohort, both medications were administered, and no medications were given in the fourth cohort. Participants were included if they had symptoms of a lacunar stroke and an MRI or CT scan that confirmed the stroke with no other cause for the symptoms. The primary outcome of this study was feasibility of a phase III trial; secondary outcomes included safety, tolerability, and treatment efficacy in terms of reducing rates of stroke, myocardial infarction, transient ischemic attack, cognitive impairment, and dementia.   

According to researchers, “We cautiously hope that these medications may have wider implications for other types of small vessel disease.” There are currently no specific treatments for lacunar stroke, which account for approximately 25% of ischemic strokes.