Abstract
Small subcortical strokes are frequent, generally share a common pathophysiology, and have not been adequately studied in randomized trials aimed at prevention. The Secondary Prevention of Small Subcortical Strokes (SPS3) phase III NIH-NINDS funded trial will enroll 2,500 with symptomatic lacunar strokes attributed to cerebral small artery disease. Patients will be randomized in a factorial design to two interventions; (1) Antiplatelet therapy: (a) aspirin 325 mg/day or (b) aspirin + clopidogrel 75 mg/day; and (2) Systolic targets of blood pressure control: (a) “intensive” <130 mmHg or (b) “usual” 130 to 149 mmHg. SPS3 aims to define the optimal intervention to prevent stroke recurrence and cognitive impairment in patients with small subcortical strokes.
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