The Effect of Cilostazol on Carotid Intima–Media Thickness Progression in Patients with Symptomatic Intracranial Atherosclerotic Stenosis

Abstract

The progression of carotid intima-media thickness (CIMT) is closely associated with ischemic stroke recurrence. However, the efficacy of cilostazol on preventing CIMT progression in stroke patients has never been investigated properly by a prospective trial. This study is a part of "Trial of Cilostazol in Symptomatic Intracranial Arterial Stenosis-2." Six centers that are available to measure CIMT according to the protocol participated in this substudy. After 7 months of randomization, the changes of CIMT were compared between cilostazol group and clopidogrel group. CIMT was measured by a semiautomated software (Intimascope) and was presented as the mean of maximum (CIMT-max) and average (CIMT-ave) of both common carotid arteries. Linear logistic regression analysis and analysis of covariance were performed to verify the independent factors associated with CIMT progression. Among the 85 patients, 39 subjects were assigned to cilostazol group and 46 subjects to clopidogrel group. Follow-up CIMT significantly decreased in cilostazol group (CIMT-max: -.03±.11 and CIMT-ave: -.02±.08) compared with the increase in clopidogrel group (CIMT-max: .04±.20 and CIMT-ave: .04±.11; P=.05 and P=.04, respectively). Female, diabetes, and smoking were independently associated with the progression of CIMT, whereas the use of cilostazol was against CIMT progression from the results of linear regression analysis (P=.03 for both CIMT-max and CIMT-ave). The use of cilostazol also well predicted less progression of CIMT at follow-up after adjusting for baseline CIMT values and conventional risk factors (CIMT-max: P=.04 and CIMT-ave: P=.03). Cilostazol has a beneficial effect in preventing the progression of CIMT in ischemic stroke patients.