Tadalafil may improve cerebral perfusion in small-vessel occlusion stroke-a pilot study

Autor: Egill Rostrup, Rasmus Hvass Hansen, Kate Lykke Lambertsen, Rikke Steen Krawcyk, Christina Kruuse, Shazia Rehman, Joakim N.E. Ölmestig, Ida R. Marlet
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Zdroj: ölmestig, J, Marlet, I R, Hansen, R H, Rehman, S, Krawcyk, R S, Rostrup, E, Lambertsen, K L & Kruuse, C 2020, ' Tadalafil may improve cerebral perfusion in small-vessel occlusion stroke-a pilot study ', Brain Communications, vol. 2, no. 1 . https://doi.org/10.1093/braincomms/fcaa020
Ölmestig, J, Marlet, I R, Hansen, R H, Rehman, S, Krawcyk, R S, Rostrup, E, Lambertsen, K L & Kruuse, C 2020, ' Tadalafil may improve cerebral perfusion in small-vessel occlusion stroke-a pilot study ', Brain Communications, vol. 2, no. 1, pp. fcaa020 . https://doi.org/10.1093/braincomms/fcaa020
Brain Communications
DOI: 10.1093/braincomms/fcaa020
Popis: New treatments for cerebral small-vessel disease are needed to reduce the risk of small-vessel occlusion stroke and vascular cognitive impairment. We investigated an approach targeted to the signalling molecule cyclic guanosine monophosphate, using the phosphodiesterase 5 inhibitor tadalafil, to explore if it improves cerebral blood flow and endothelial function in patients with cerebral small-vessel disease and stroke. In a randomized, double-blinded, placebo-controlled, cross-over pilot trial (NCT02801032), we included patients who had a previous (>6 months) small-vessel occlusion stroke. They received a single dose of either 20 mg tadalafil or placebo on 2 separate days at least 1 week apart. We measured the following: baseline MRI for lesion load, repeated measurements of blood flow velocity in the middle cerebral artery by transcranial Doppler, blood oxygen saturation in the cortical microvasculature by near-infrared spectroscopy, peripheral endothelial response by EndoPAT and endothelial-specific blood biomarkers. Twenty patients with cerebral small-vessel disease stroke (3 women, 17 men), mean age 67.1 ± 9.6, were included. The baseline mean values ± standard deviations were as follows: blood flow velocity in the middle cerebral artery, 57.4 ± 10.8 cm/s; blood oxygen saturation in the cortical microvasculature, 67.0 ± 8.2%; systolic blood pressure, 145.8 ± 19.5 mmHg; and diastolic blood pressure, 81.3 ± 9.1 mmHg. We found that tadalafil significantly increased blood oxygen saturation in the cortical microvasculature at 180 min post-administration with a mean difference of 1.57 ± 3.02%. However, we saw no significant differences in transcranial Doppler measurements over time. Tadalafil had no effects on peripheral endothelial function assessed by EndoPAT and endothelial biomarker results conflicted. Our findings suggest that tadalafil may improve vascular parameters in patients with cerebral small-vessel disease stroke, although the effect size was small. Increased oxygenation of cerebral microvasculature during tadalafil treatment indicated improved perfusion in the cerebral microvasculature, theoretically presenting an attractive new therapeutic target in cerebral small-vessel disease. Future studies of the effect of long-term tadalafil treatment on cerebrovascular reactivity and endothelial function are needed to evaluate general microvascular changes and effects in cerebral small-vessel disease and stroke.
A reduced cerebral blood flow is well known in cerebral small-vessel disease. In this pilot trial, we found that tadalafil may increase cerebral microperfusion in small-vessel occlusion stroke. This is interesting, since it suggests a new target in treating this cerebrovascular disease. A larger clinical trial is planned.
Graphical Abstract
Databáze: OpenAIRE
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