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

Background: 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. Methods: 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. Results: 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). Conclusion: Cilostazol has a beneficial effect in preventing the progression of CIMT in ischemic stroke patients.