World Stroke Day 2025

World Stroke Day is a fantastic opportunity to highlight the importance of preventing stroke, improving survivors’ quality of life, and supporting vital research. At the Row Fogo Centre for Research into Ageing and the Brain, we understand cerebral small vessel disease to be a key factor in stroke risk, and we are working towards finding real-world treatments.

One in four strokes is caused by damage to the brain’s smallest blood vessels, often leading to lasting cognitive decline. Until now, there has been no proven treatment.

The Row Fogo Centre for Research into Ageing and the Brain is leading LACI‑3, a UK‑wide clinical trial testing two existing medicines—cilostazol and isosorbide mononitrate—to see if they can reduce disability and protect brain health after lacunar stroke.

Milestone reached

A major milestone in stroke research was reached on 7th July 2025 as the first participant was successfully recruited to the highly anticipated LACI-3 trial, a UK-wide study aiming to transform care for thousands of people who experience lacunar strokes each year.

LACI-3, or the Lacunar Intervention Trial 3, is a unique and ambitious clinical trial testing whether two existing medications—cilostazol and isosorbide mononitrate—that are widely used in other diseases, can help prevent further strokes, problems with memory and thinking, mobility issues, and even dementia, in people who have suffered a lacunar stroke.

Lacunar strokes, caused by damage to the small blood vessels deep within the brain, account for around a quarter of all strokes and affect around 35,000 people annually in the UK. Despite this, there are currently no proven treatments that directly target the small vessel damage that causes these strokes and can prevent their long-term consequences.

LACI-3 builds on the LACI-2 study, which showed that both cilostazol and isosorbide mononitrate were safe and well tolerated after lacunar stroke. LACI-3 will go further, involving over 1,300 participants across a network of 60 hospitals in the UK, to determine whether these drugs can actually reduce the risk of cognitive decline and further strokes and improve quality of life.

Both drugs are already widely used for other cardiovascular conditions (cilostazol for poor blood flow in the legs and isosorbide mononitrate for angina), but have never before been tested in this way for lacunar stroke and small vessel disease. They are widely available, and if LACI-3 shows that either or both drugs improve outcomes, then they could be taken into clinics rapidly after the end of LACI-3.

The trial is a randomised controlled study in which participants will receive either one of the drugs, both drugs, or neither (alongside standard care), with researchers following up participants for 18 months. The goal is to find out whether the medications can be safely used over the long term and whether they provide meaningful protection for the brain.

LACI-3 is such an important study, the only large trial in lacunar stroke, with the potential to improve outcomes after lacunar stroke, and others with small vessel disease in the future too.

Patients aged 30 and over who have recently 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.