Efficacy of cilostazol for intracranial arterial stenosis evaluated by digital subtraction angiography/magnetic resonance angiography

Abstract

Intracranial arterial stenosis is an important factor in the development of cerebral infarction; however, no effective treatment has been established. A phosphodiesterase 3 (PDE3) inhibitor, cilostazol, has been reported to suppress progression of symptomatic intracranial arterial stenosis in combination with aspirin, but the study used magnetic resonance angiography (MRA) for evaluation, which is not considered optimal for assessment of stenotic lesions. A preliminary study was conducted to investigate the efficacy of cilostazol using MRA and intra-arterial digital subtraction angiography (DSA). DSA was performed in 18 patients for whom intracranial arterial stenosis was suspected from MRA. Cilostazol (200 mg/day) was administered orally for 1 year to 13 patients with 16 lesions (nine symptomatic, seven asymptomatic) confirmed by DSA. MRA and DSA were repeated at 6 and 12 months. Through MRA at 6 and 12 months, regression was observed in nine (56.3%) and eight (50.0%) patients, six (37.5%) and seven (43.8%) patients remained stationary, and one (6.3%) and one (6.3%) patient progressed, respectively. From DSA, percent stenosis for all lesions significantly improved from 49.2 (±15.4%) to 42.6 (±12.7%) at 12 months (P=0.023). In nine symptomatic lesions, stenosis was 55.3 (±7.3%) at baseline, 46.3 (±12.5%) at 6 months (P=0.029), and 47.7 (±9.9%) at 12 months (P=0.049). In contrast, in seven asymptomatic lesions, no significant improvement was observed at 6 months (P=0.113) or 12 months (P=0.157). When evaluated by severity, there was a significant improvement in 11 lesions with ≥50% stenosis, but no significant improvement was observed in five lesions with <50% stenosis. No patient developed symptomatic stroke events. Cilostazol may induce improvement of symptomatic intracranial arterial stenosis or severe lesions. A combination of MRA and DSA might be another diagnostic option for more precise examination.