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Strokes are a serious and life-threatening medical emergency caused by a lack of blood to the brain. There are various different types of strokes, for which the reason for the lack of blood will be different. One such type of stroke is a lacunar stroke, which affects around 25,000 people in the UK every year.
It is thought lacunar strokes are caused by cerebral small vessel disease (cSVD), where small blood vessels deep within the brain are damaged and stop working properly.
They can be particularly distressing as patients may go on to develop problems with their thinking and memory, movement, and even dementia.
Unfortunately there are currently no effective treatments for this.
However, new research, carried out by the Universities of Edinburgh and Nottingham and the UK Dementia Research Institute, could be about to change this.
Two cheap and commonly used drugs could be repurposed as the first specific treatment for people who experience lacunar strokes.
A clinical trial, funded by the British Heart Foundation (BHF), has discovered that isosorbide mononitrate and cilostazol, which are used to treat other heart and circulatory diseases, can improve the debilitating outcomes people experience after a lacunar stroke.
They were even more effective when used in combination.
Medical director at the BHF, Professor Nilesh Samani 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.”
As part of the trial, 363 people who had experienced a lacunar stroke were split into groups.
They all underwent standard stroke prevention treatment, but participants took either isosorbide mononitrate or cilostazol individually, both drugs together, or neither, for one year.
At the end of the trial, those who took both drugs were nearly 20 percent less likely to have problems with their thinking and memory compared to the group that did not take either drug.
These patients were also noted to be more independent and reported a better quality of life.
Participants who took isosorbide mononitrate were less likely to have had further strokes at one year than those who did not take the drug.
It was found that on its own isosorbide mononitrate also improved thinking and memory skills, and quality of life, while cilostazol improved independence and mood – but these effects were stronger when the two drugs were taken together.
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.”
The team is now planning to test these drugs in a larger four-year clinical trial, which they hope to start by the end of 2023.
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