New hope for lacunar stroke treatment

New hope for lacunar stroke treatment
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Two cheap and common drugs could be repurposed as a new treatment for lacunar stroke, a specific type of stroke linked to nearly half of all dementias.

A lacunar stroke is a type of ischemic stroke that occurs when blood flow to one of the small arteries deep within the brain becomes blocked. 

They affect around 25,000 people in the UK each year and can cause memory and movement problems.

Researchers from the University of Nottingham and the University of Edinburgh conducted a clinical trial that has shown two medications already used in healthcare could safely and effectively improve outcomes that people experience following lacunar stroke.

Repurposing medications to treat lacunar stroke

Isosorbide mononitrate and cilostazol are currently used to treat other heart and circulatory diseases. They could be available for treatment for lacunar strokes within five years if the results are confirmed in further trials.

Professor Joanna Wardlaw, Chair of Applied Neuroimaging at the University of Edinburgh and Foundation Chair at the UK Dementia Research Institute, said: “Up until now, lacunar strokes have been treated just like other types of stroke, but lacunar stroke is clearly different. Now we understand more about what is triggering these strokes to attack the brain, we’ve been able to focus our efforts on treatments that can put a halt to this damage.”

“We need to confirm these results in larger trials before either drug can be recommended as a treatment. However, as these drugs are already widely available for other circulatory disorders and inexpensive, it shouldn’t take too long to move our findings from research into everyday clinical practice.”

Improving patient outcomes

The trial involved 363 people who had experienced a lacunar stroke. Alongside standard stroke prevention treatment, participants either took isosorbide mononitrate or cilostazol individually, both drugs together, or neither, for one year.

The researchers investigated cilostazol and isosorbide mononitrate as they are believed to improve the function of the inner lining of blood vessels (the endothelium). Problems with the endothelium are thought to play a role in cerebral small vessel disease (cSVD).

After one year, participants taking both drugs were nearly 20% less likely to have problems with their thinking and memory compared to the group that did not take either drug. They were also more independent and reported a better quality of life.

Furthermore, patients taking isosorbide mononitrate were less likely to have had further lacunar strokes than those who did not take the drug. It also improved thinking and memory skills, and quality of life, whereas, cilostazol improved independence and mood. These effects were strengthened when they were taken together.

The team is now planning to test these drugs in a larger four-year clinical trial, which they hope will start by the end of 2023.

Professor Sir Nilesh Samani, Medical Director at the British Heart Foundation, which funded the trial, said: “These promising findings provide a long-awaited positive step towards the first treatments becoming available for lacunar strokes, offering much-needed hope for thousands of people.

“Lacunar strokes are not the only way that cerebral small vessel disease can affect someone. These findings also open new avenues of research into other conditions related to small vessel disease, such as vascular dementia.”



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