WSC 2026 | New treatments in development for cerebral small vessel disease
Joanna Wardlaw, CBE, MB ChB (Hons), MD, FRCR, FRCP, FMedSci, FRSE, The University of Edinburgh, Edinburgh, UK, discusses new treatments in development for cerebral small vessel disease. Prof. Wardlaw highlights the potential of isosorbide mononitrate and cilostazol, and drugs like Viagra, but emphasizes that more trials are needed to determine their efficacy. This interview took place at the 18th World Stroke Congress (WSC) in Seoul, Korea.
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Transcript
There are several drugs that already are in use for other conditions, blood vessel diseases, blood vessel diseases, cardiovascular diseases, which have promising effects on the blood vessels in the brain that we think are the problem in small vessel disease and lacunar stroke. And so some of them are already in clinical trials and others are planned for clinical trials and at this point it’s hard to say which if any might be more or less likely to succeed...
There are several drugs that already are in use for other conditions, blood vessel diseases, blood vessel diseases, cardiovascular diseases, which have promising effects on the blood vessels in the brain that we think are the problem in small vessel disease and lacunar stroke. And so some of them are already in clinical trials and others are planned for clinical trials and at this point it’s hard to say which if any might be more or less likely to succeed. So far there is the most evidence for two drugs called isosorbide mononitrate and cilostazol. But that’s just because they started being tested a bit longer ago. There’s other trials starting which are going to test drugs like Viagra and other drugs of that nature because they have some similar effects on the blood vessels in the brain and there’s some very preliminary data to suggest that they might they might have you know promising modes of action and they’re certainly worth testing. And then after that there are many other compounds which you know some of them are available in some parts of the world for example in as in Asia-Pacific countries, there are a number of compounds in use, you know, drugs called things like butylphthalide, which, you know, actually there’s a lot of evidence for some benefit in stroke as well as small vessel disease. A lot of the evidence for cilostazol comes from Asia-Pacific countries. But like cilostazol, some of the, you some of these other drugs are hardly used in the West. So actually, there may be other compounds that we don’t really know about in the West that are very promising in Asia-Pacific populations. And just knowing more about it would mean that we could be sort of testing them in each other’s countries. So we need more trials is basically the answer. It’s hard to second guess which ones might be more or less effective. One can hope, but having been involved in trials for many, many, many years, you can have a very promising agent that just does absolutely nothing when you get to the large trial. So you have to be quite pragmatic.
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