Long-Term Sequential Dual Antiplatelet Therapy Based on Cilostazol in Symptomatic Intracranial Arterial Stenosis

Who can take part

• Age: 18-80 years old
• Acute mild non-cardioembolic stroke
• Ischemic stroke or transient ischemic attack (TIA) occurring 2 to 4 weeks prior to enrollment
• NIHSS score ≤15 at enrollment and pre-stroke mRS score ≤2
• Ischemic stroke or TIA attributable to the territory of the qualifying intracranial artery
• Symptomatic 70%-99% intracranial atherosclerotic stenosis confirmed by DSA, CTA, or MRA
• Completion of 3 months of standard dual antiplatelet therapy (DAPT)
• Medication adherence ≥80% during the 3 months of standard DAPT
• High risk for recurrent stroke (defined by at least one prespecified high-risk feature) at the second screening after 3 months of standard DAPT
• No intracranial endovascular or surgical revascularization within the preceding 3 months
• No newly developed contraindications to cilostazol-based DAPT or single antiplatelet therapy
• Signed informed consent by the patient or legally authorized representative

Who cannot take part

• Current or previous severe heart failure
• Severe bleeding event within the previous 6 months, including spontaneous intracranial hemorrhage, major gastrointestinal bleeding, or other bleeding requiring blood transfusion
• High-risk cardioembolic source requiring or potentially requiring long-term anticoagulation, including persistent or paroxysmal atrial fibrillation, mechanical heart valve or severe valvular disease, intracardiac thrombus, recent myocardial infarction with significant wall-motion abnormality, or severe cardiomyopathy
• Stroke or TIA caused by nonatherosclerotic disease, including moyamoya disease, vasculitis, arterial dissection, or other definite nonatherosclerotic causes
• Known allergy or serious adverse reaction to cilostazol, aspirin, clopidogrel, ticagrelor, or other antiplatelet agents
• Significant bleeding tendency or coagulation abnormality
• Medical condition requiring long-term oral anticoagulation
• Active malignancy or other serious illness with a life expectancy of less than 1 year
• Severe cognitive impairment or psychiatric illness that would prevent adherence to study treatment or long-term follow-up