AROUND one in five stroke victims in Scotland could benefit from two cheap drugs already commonly used to treat other cardiovascular conditions.

The findings of a preliminary study, led by researchers from the universities of Edinburgh and Nottingham, could pave the way to the first effective treatment for patients who suffer what is known as a lacunar stroke.

The results were presented for the first time at an international conference of the American Stroke Association in Dallas.

Around 1700 to 2000 people a year in Scotland experience a lacunar stroke - roughly 20 per cent of all stroke cases.

It is a form of ischaemic stroke where a blood clot blocks the flow of blood and oxygen to the brain.

However, the lacunar type occurs in the small blood vessels deep in the brain.

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They are thought to be caused by cerebral small vessel disease (cSVD) and can have distressing effects for survivors who may develop problems with memory, thinking, movement, and even dementia.

There is currently no standard medical therapy for lacunar stroke, but scientists sought to evaluate whether two commonly used cardiovascular medications - cilostazol and isosorbide mononitrate - could be used safely in this patient group.

The initial study involved around 360 patients enrolled between February 2018 and May 2022 from 26 stroke centres across the UK and split randomly into four groups. The average age was 64, and two thirds of participants were male.

One group received daily doses of oral isosorbide, which is normally used to treat chest pain by relaxing the blood vessels and reducing blood pressure.

Another group was given daily doses of cilostazol, a drug typically prescribed for peripheral artery disease which is known to improve blood flow by relaxing blood vessels and reducing clotting.

A third group received daily doses of both drugs, and a control group received neither. All patients continued to take their normally prescribed medications.

After one year, participants who took 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.

Those who took isosorbide mononitrate were less likely to have had further strokes at one year than those who did not take the drug.

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Individually isosorbide mononitrate also improved thinking and memory skills, and quality of life, while cilostazol improved independence and mood. But these effects were strengthened when the two drugs were taken together.

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.

They are also looking to test whether the drugs are effective in different conditions linked to cSVD, such as vascular cognitive impairment and dementia.

Professor Joanna Wardlaw, chair of Applied Neuroimaging at Edinburgh University and foundation chair at the UK Dementia Research Institute - which helped support the trial - 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.”

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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."

Ian Reynolds, 57, from Edinburgh was among the 363 people to take part in the trial after suffering a lacunar stroke in July 2020.

Mr Reynolds said: “It started with a tingle in my left hand, but within a couple of hours a numbness had spread up my left side and then right up to my face.

"I had never experienced anything like it before. To be honest, I didn’t even register what was going on. When the doctors told me I might have had a stroke, I thought ‘Me? No way’.”

Once scans confirmed he had had a lacunar stroke, Mr Reynolds was asked to take part in the trial. 

He was part of the group that took cilostazol alone.

Two and a half years after his stroke, he still has numbness and weakness in his left arm and leg.

However, he was able to return to work as a driver six months after his stroke.

Mr Reynolds said: “I’m determined that this will not stop me living my life.

“My experience could have been very different, and I realise just how lucky I have been.

“It looks like the drugs have helped a lot of people, which can only be good news. Far too many are living with the after-effects of this type of stroke, so finding a treatment would be fantastic.”