DL-3-n-butylphthalide improves cerebral hypoperfusion in patients with large cerebral artherosclerotic stenosis. A single-center, randomized, double-blind, placebo-controlled study.
Abstract Background: DL-3-n-butylphthalide (NBP) was demonstrated to increase the cerebral blood flow (CBF) in the animal models, but there are no clinic studies to verify this. We aimed to explore the effect of NBP on improving cerebral hypoperfusion caused by cerebral large-vessel stenosis. Methods: In this single-center, randomized, double-blind, placebo-controlled study, 120 patients with severe carotid atherosclerotic stenosis and cerebral hypoperfusion in the ipsilateral middle cerebral artery (MCA) were included and randomly assigned into the NBP or placebo group as 1:1 radio. Patients in NBP and placebo group received 200mg and 20mg of NBP capsules three times daily for four weeks respectively. Single photon emission computed tomography (SPECT) were used to assess regional CBF (rCBF) in four regions of interest (ROIs) corresponding to MCA before and 12 weeks after the treatment. The rC BF change for every ROI and the CBF change in whole MCA territory for every patient after therapy were classified into amelioration, stabilization and deterioration respectively. Results: 48 NBP patients (6 with bilateral stenosis) and 46 placebo patients (8 with bilateral stenosis) completed the trial. Both groups had 54 stenotic carotid arteries and 216 ROIs for rCBF change analysis. After therapy, the rCBF in ROIs increased in NBP group (83.5%±11.4% vs. 85.8%±12.5%, p=0.000), but had no change in placebo group (86.9%±11.6% vs. 87.8%±11.7%, p=0.331). There was higher percentages of ROIs with rCBF amelioration and stabilization in NBP group than in placebo group (93.1% vs. 79.2%, p=0.000). Ordinal regression analysis showed that NBP independently made more patients to have whole CBF amelioration in ipsilateral MCA than placebo (Wald-χ2=5.247, OR=3.31, p=0.022). Conclusions: NBP may improve the cerebral hypoperfusion in the patients with carotid artery atherosclerotic stenosis. Trial registration: Chinese Clinical Trial Registry, ChiCTR1900028005, registered December 8th 2019- Retrospectively registered, http://www.chictr.org.cn/edit.aspx?pid=45490&htm=4.