2022 年 39 巻 3 号 p. 351-355
Long–term benefit of dual antiplatelet therapy (DAPT) over single antiplatelet therapy (SAPT) for the prevention of recurrent stroke has not been established in patients with intracranial arterial stenosis. We compared the efficacy and safety of DAPT with cilostazol and clopidogrel or aspirin to those of SAPT with clopidogrel or aspirin in patients with intracranial arterial stenosis, who were recruited to the Cilostazol Stroke Prevention Study for Antiplatelet Combination (CSPS.com) trial, a randomized controlled trial in high–risk Japanese patients with ischemic stroke. We compared the vascular and hemorrhagic events between DAPT and SAPT in patients with ischemic stroke and intracranial arterial stenosis of at least 50% in a major intracranial artery. 275 patients were randomly assigned to receive DAPT and 272 patients SAPT. The risks of ischemic stroke (hazard ratio [HR], 0.47 ; 95% CI, 0.23–0.95) ; and composite of stroke, myocardial infarction, and vascular death (HR, 0.48 ; 95% CI, 0.26–0.91) were lower in DAPT than SAPT, whereas the risk of severe or life–threatening bleeding (HR, 0.72 ; 95% CI, 0.12–4.30) did not differ between the 2 treatment groups. In conclusion, DAPT using cilostazol was superior to SAPT with clopidogrel or aspirin for the prevention of recurrent stroke and vascular events without increasing bleeding risk in patients with ischemic stroke and intracranial arterial stenosis.
