Objective: To compare the effects of cilostazol on cerebral arteries and cerebrovascular blood flow in secondary prevention of ischemic stroke, with those of aspirin.
Methods: Sixty-eight patients who had ischemic stroke during the recent 1-6 months were recruited and randomized into cilostazol or aspirin group. Cerebrovascular condition was assessed by magnetic resonance angiography (MRA) and transcranial doppler ultrasonography (TCD) at the beginning of the study and after 12-month medication.
Results: During the clinical follow-up, ischemic stroke recurred in 2 patients in cilostazol group, while in aspirin group, one case of ischemic stroke recurrence and one case of acute myocardial infarction were found. MRA revealed that in aspirin group, the percentages of patients experiencing aggravation and attenuation of cerebrovascular condition were 3.3% and 6.7%, respectively, while in aspirin group, they were 3.3% and 10%, respectively. Moreover, TCD revealed that 26.9% of the patients in aspirin group and 14.3% of the patients in cilostazol group experienced aggravation of cerebrovascular condition. However, the systolic peak flow velocity of the previously abnormal arteries increased by 42.9% after 12-month medication of cilostazol, which was significantly higher than that after aspirin medication (27.5%) (P = 0.04). Furthermore, as a major side effect of antiplatelet therapy, the frequency of bleeding was much less in cilostazol group (0 case in cilostazol group vs 5 in aspirin, P< 0.05).
Conclusion: Cilostazol is as effective as aspirin in preventing the aggravation of cerebral arteries in secondary prevention of ischemic stroke. Besides, it is more safe. Cilostazol can increase the systolic peak flow velocity of cerebral arteries, which may improve the blood supply of focal ischemia.
目的: 观察西乐他唑与阿司匹林在脑梗死二级预防中对脑血맜状况和脑血流的影响, 并作比较。
方法: 选取在近1–6 个月内有脑梗死病史患者68 例, 随机分配入西乐他唑和阿司匹林组。 在入组时及用药12 个月后, 应用核磁共振血맜成像(MRA)和经颅多普勒超声(TCD)方法评价患者脑血맜状况。
结果: 随访期间, 西乐他唑组有2例患者再发脑梗死, 而阿司匹林组有1 例再发脑梗死, 1 例发生急性心肌梗死。 MRA 检测发现, 西乐他唑组患者血맜状况恶化和好转的比例分别为3.3%和6.7%, 阿司匹林组分别为3.3%和10.0%。 TCD检测显示西乐他唑和阿司匹林组患者血맜状况恶化发生的比例分别为14.3%和26.9%。 以上结果两组间均无统计学差异。 服用西乐他唑12个月后, 血流异常的血맜中其收缩期血流峰值升高的比例高于阿司匹林组, 分别为42.9%和27.5%。 作为抗血小板治疗的主要副作用, 出血事件在西乐他唑组发生0 例, 在阿司匹林组发生5 例(P < 0.05)。
结论: 西乐他唑在脑梗死二级预防中同阿司匹林一样有效且比阿司匹林更为安全。 西乐他唑能升高脑血맜峰值血流速度, 改善缺血灶血供。