A major milestone in stroke research was reached on 31st July 2026 as the 260th participant, marking a fifth of the way to target recruitment, successfully joined the LACI-3 trial, a UK-wide study aiming to transform care for tens of thousands of people who experience lacunar strokes each year. LACI-3, or the Lacunar Intervention Trial 3, is a unique and ambitious clinical trial managed by personnel based at Edinburgh and Nottingham Universities to test whether two existing medications—isosorbide mononitrate and cilostazol — can help prevent problems with memory and thinking, mobility issues, further strokes, and even dementia, in people who have suffered a lacunar stroke.Lacunar strokes are a form of small vessel disease, caused by damage to the small blood vessels deep within the brain so it is impossible to gain access to repair them. They account for around a quarter of all strokes, about 35,000 people each year in the UK alone with the major long-term consequence of cognitive decline, affecting about half of all patients. Small vessel disease is a worldwide problem, affecting approximately 700 million people in every country and is a major cause of stroke and dementia. Despite this, there is currently no proven treatment or drugs available anywhere in the World which can reduce small vessel damage and prevent subsequent stroke or dementia. We are delighted that LACI-3 has passed this important milestone in just over a year. We are deeply grateful to the patients who have joined the trial. For those affected by lacunar strokes, many of whom face long-term difficulties with thinking, walking, and independence, the potential impact of this trial to improve long term outcomes after lacunar stroke is considerable Professor Joanna Wardlaw Chief Investigator for the LACI-3 study LACI-3 builds on the successful LACI-1 and LACI-2 studies, which showed isosorbide mononitrate and cilostazol were safe, well tolerated, reduced stroke risk, cognitive decline, improve independence, quality of life and protect the brain after lacunar stroke. The LACI-3 trial, funded by the UK National Institute of Health and Care Research, is so much bigger, involving up to 1,300 participants from 60 hospitals throughout the UK, treated over an 18-month period. LACI-3 is very important because it is the only large-scale trial with the potential to improve patients’ lives after lacunar stroke and other forms of small vessel disease in the future.Both drugs are already widely used for other disorders - isosorbide mononitrate for angina and cilostazol for poor blood flow in the legs so both are safe and approved. If LACI-3 shows either or both drugs improve stroke outcomes, they can be approved and in use much quicker than new drugs. This trial has all the hallmarks of being a success which could bring hope and comfort to patients, their family and carers for a better life.Patients aged 30 and over who have had a lacunar stroke may be eligible to take part. Participants can be referred through their treating hospital, or self-refer to a participating centre.For more information about the trial and how to get involved, visit the LACI-3 website or speak to your local stroke team.To learn more about Cerebral Small Vessel Disease (SVD), click here. This article was published on Thursday 3 September 2026
