WSO - April 2023 - 430

430
International Journal of Stroke 18(4)
Figure 2. The Kaplan-Meier curves for the time to the first
event of (a) ischemic stroke and (b) composite of stroke,
myocardial infarction, and vascular death in patients with
extracranial arterial stenosis after ischemic stroke. Intentionto-treat
analysis for (a) and (b).
Figure 3. Kaplan-Meier curves for the time to the first
event of (a) ischemic stroke and (b) composite of stroke,
myocardial infarction, and vascular death in patients without
extracranial or intracranial arterial stenosis after ischemic
stroke. Intention-to-treat analysis for (a) and (b).
HR, hazard ratio; CI, confidence interval; dual therapy, cilostazol plus
aspirin or clopidogrel; monotherapy, aspirin or clopidogrel alone.
CSPS.com trial, the risk of recurrent ischemic stroke was
similar between DAPT and SAPT during 8 to 14 days after
stroke onset, while it was lower in DAPT than SAPT during
15 to 180 days.20 Though not only symptomatic but also
asymptomatic ECAS was included in this study, the subtype
of original stroke was large artery atherosclerosis in
majority of patients with ECAS, in whom the proportion of
large artery atherosclerosis in recurrent stroke was similar
between DAPT and SAPT. In patients with ECAS, DAPT
with cilostazol did not reduce recurrent ischemic stroke
both between 8 and 14 days and between 15 and 180 days
after stroke onset (Supplemental Table 3). These results
suggest that DAPT with cilostazol is not beneficial for the
prevention of acute atherothrombotic stroke in patients
with ECAS.
In contrast, DAPT was superior to SAPT for the prevention
of recurrent stroke and vascular events in patients
International Journal of Stroke, 18(4)
HR, hazard ratio; CI, confidence interval; dual therapy, cilostazol plus
aspirin or clopidogrel; monotherapy, aspirin or clopidogrel alone.
without arterial stenosis. Patients without arterial stenosis
on magnetic resonance angiography in this study largely
included lacunar stroke. Cilostazol, a phosphodiesterase
inhibitor, is likely to prevent recurrent stroke by various
pleiotropic effects, including antiplatelet, vasodilating,
anti-inflammatory, antiatherogenic, and protective effects
on endothelial function.3,21,22 Several potential mechanisms
have been described for the pathogenesis of lacunar
stroke.23 These include lipohyalinosis, atherosclerosis, and
cardiogenic embolism. In addition, some studies hypothesized
that endothelial dysfunction and impaired autoregulation
as well as extravasation of blood products into the
vessel wall may be contributing factors to the development
of lacunar infarcts.24 Cilostazol might prevent the longterm
process leading to the obstruction of small vessels by
attenuating these mechanisms through the pleiotropic
effects. In this study, the proportion of small vessel

http://www.CSPS.com

WSO - April 2023

Table of Contents for the Digital Edition of WSO - April 2023

Contents
WSO - April 2023 - Cover1
WSO - April 2023 - Cover2
WSO - April 2023 - 375
WSO - April 2023 - Contents
WSO - April 2023 - 377
WSO - April 2023 - 378
WSO - April 2023 - 379
WSO - April 2023 - 380
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WSO - April 2023 - Cover3
WSO - April 2023 - Cover4
https://europe.nxtbook.com/nxteu/sageuk/wso_202404
https://europe.nxtbook.com/nxteu/sageuk/ukstrokeforum_202402_supp
https://europe.nxtbook.com/nxteu/sageuk/wso_202403
https://europe.nxtbook.com/nxteu/sageuk/wso_202402
https://europe.nxtbook.com/nxteu/sageuk/wso_202401
https://europe.nxtbook.com/nxteu/sageuk/wso_2023123_US_UKOnly
https://europe.nxtbook.com/nxteu/sageuk/wso_2023123_ROW
https://europe.nxtbook.com/nxteu/sageuk/wso_2023101
https://europe.nxtbook.com/nxteu/sageuk/wso_202308
https://europe.nxtbook.com/nxteu/sageuk/wso_202307
https://europe.nxtbook.com/nxteu/sageuk/wso_202306
https://europe.nxtbook.com/nxteu/sageuk/wso_202304
https://europe.nxtbook.com/nxteu/sageuk/wso_202303
https://europe.nxtbook.com/nxteu/sageuk/wso_202302
https://europe.nxtbook.com/nxteu/sageuk/wso_202301
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