Role of Glucagon-like Peptide 1 Receptor Agonist (GLP1 RA) Dulaglutide on Cerebral Hemodynamics in Patients With Severe and Symptomatic Stenosis of Intracranial Internal Carotid or Middle Cerebral Artery With Impaired Cerebral Vasodilatory Reserve - an Open-label Randomised Clinical Trial

What this Trial Is About

This research aims to evaluate the effect of glucagon-like peptide 1 receptor agonist (GLP1 RA) therapy, specifically Dulaglutide, on patients with severe and recently symptomatic narrowing (stenosis) of the intracranial carotid artery (ICA) or middle cerebral artery (MCA). The study focuses on improving cerebral vasodilatory reserve (CVR), an important measure of blood vessel function in the brain, in patients with intracranial atherosclerotic disease (ICAD). Researchers hypothesize that GLP1 RA may benefit these patients by improving blood flow and reducing stroke risk. Participants will be randomly assigned to receive either the best medical therapy alone or in combination with Dulaglutide given as a weekly subcutaneous injection starting at 0.75 mg and possibly increasing to 1.5 mg. The study is open-label and lasts for two years, with CVR measured at baseline and after one year using transcranial Doppler breath holding index and acetazolamide-challenged single photon emission computed tomography (SPECT). Brain MRI scans will also be performed to check for new ischemic lesions. Throughout the study, participants will be monitored for cerebral ischemic events for two years. Researchers will assess changes in CVR and the occurrence of strokes, transient ischemic attacks (TIA), myocardial infarctions, and major adverse cardiovascular events (MACE). Safety will be tracked by recording any side effects related to Dulaglutide. The trial aims to provide important information about the potential benefits of GLP1 RA therapy in managing severe ICAD.

Role of GLP1 RA Dulaglutide on Severe Intracranial Atherosclerosis