Kim BC, Youn YC, Jeong JH, et al. - In patients having cerebral small vessel disease, no significant difference was found between the impacts of cilostazol and aspirin on white matter change (WMC) progression.

• A multicenter, double-blind, randomized controlled trial of 256 patients with moderate or severe WMCs and at least one lacunar infarction identified on brain magnetic resonance imaging.

• Patients were randomized to the cilostazol (n=127) and aspirin (n=129) groups; cilostazol slow release (200 mg) or aspirin (100 mg) capsules were given once daily for 2 years.

• Both groups, over 2 years, exhibited an increase in the percentage of WMC volume to total WM volume and in the percentage of WMC volume to intracranial volume, however, neither analysis demonstrated significant differences between the groups.

• The aspirin group showed significant decrease in the peak height of the mean diffusivity histogram in normal-appearing WMs, vs the cilostazol group.

• A significant reduction in the risk of ischemic vascular event was conferred by cilostazol vs aspirin (0.5 vs 4.5 cases per 100 person-years; hazard ratio, 0.11 [95% CI, 0.02–0.89]).