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Stroke, LacunarPhase 3NCT07252544

Isosorbide Mononitrate and Butylphthalide to Reduce the Risk of Disability in Patients With Acute Lacunar Stroke (IMPACT)

A Phase 3 study testing Isosorbide Mononitrate and Butylphthalide in people with Stroke, Lacunar and Stroke, Acute Ischemic, run by Beijing Tiantan Hospital.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

The goal of this multicenter, double-blind, 2×2 factorial randomized controlled trial is to evaluate the efficacy and safety of isosorbide mononitrate, butylphthalide, and their combination in reducing disability in patients with acute lacunar stroke. Read more about this study

Who is it for?
Ages 30 years and older
What is being tested?
Isosorbide Mononitrate and Butylphthalide
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
3,156 participants
Where
No sites listed yet
Study dates
1 Dec 2025to 29 Feb 2028
Phase
Phase 3
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 30 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age ≥ 30 years;
  • Clinical lacunar syndrome within 7 days;
  • Brain CT/MRI after symptom onset:
  • a relevant (in time and location) acute lacunar infarct;
  • if no relevant lesion, symptom duration >24 hours, with no other suspected stroke etiologies (such as cerebral hemorrhage, cortical infarction, seizures, etc.)
  • MoCA score meeting the following criteria:
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  • MoCA ≥ 13 if educated ≤ 6 years;
  • MoCA ≥ 15 if 7 ≤ educated ≤ 12 years;
  • MoCA ≥ 18 if educated ≥ 13 years;
  • mRS ≤ 1 prior to this episode;
  • Patient or a legally authorized representative signed informed consent.

Who cannot join

  • Ischemic stroke of large artery atherosclerosis, cardioembolism, or other etiologies (TOAST classification);
  • Diagnosed or suspected hereditary CSVD;
  • Intracerebral hemorrhage within the past 3 months including parenchymal, intraventricular, subarachnoid hemorrhage, subdural/epidural hematoma;
  • Neurodegenerative diseases or systemic diseases that may lead to cognitive impairment, such as Alzheimer's disease, mixed dementia, Parkinson's disease, systemic autoimmune diseases, hepatic encephalopathy, or uremic encephalopathy.
  • Previously diagnosed psychiatric disorders (DSM-5 criteria).
  • Other active neurological disorders (e.g., recurrent seizures, brain tumors, vascular malformations, untreated aneurysms >3 mm).
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  • Hypotension (seated systolic blood pressure <100 mmHg), bradycardia (heart rate <60 bpm), sick sinus syndrome or severe cardiopulmonary disease.
  • History of congestive heart failure, acute myocardial infarction or other severe cardiac dysfunctions (NYHA Class III-IV).
  • Coagulation disorders, bleeding tendency or systemic bleeding, including but not limited to prothrombin time >3×upper limit of normal (ULN), platelet count <50×109/L, hemophilia, capillary fragility, gastrointestinal bleeding, urinary tract bleeding, hemoptysis, or vitreous hemorrhage, etc.
  • Severe hepatic or renal insufficiency (note: severe hepatic insufficiency is defined as ALT or AST > 3×ULN or acute hepatitis, chronic active hepatitis, cirrhosis; severe renal insufficiency is defined as eGFR < 45 ml/min/1.73m², creatinine clearance < 40 ml/min, or known chronic kidney disease of stage 3 or higher).
  • Head trauma, intracranial or spinal surgery, major surgical procedures or severe trauma within the past 4 weeks.
  • ISMN or NBP use within the past 3 days.
  • Have contraindications to ISMN or NBP, or allergy to their components.
  • Have to use the contraindicated drugs of this trial for a long time.
  • Pregnant, breastfeeding or planning to pregnant during this study.
  • Unable to tolerate MRI or with MRI contraindications.
  • Have severe diseases or expected survival <12 months.
  • Participate in other clinical trials within 30 days before this trial.
  • Unlikely to comply with study procedures and follow-up procedures for whatever reason in the opinion of the research physician.

Trial locations and contacts

No sites are listed yet. Contact the study team or a site near you to ask about taking part.

About this study

Official title: Isosorbide Mononitrate and Butylphthalide to Reduce the Risk of Disability in Patients With Acute Lacunar Stroke: a 2×2 Factorial Randomized Controlled Trial (IMPACT)

The goal of this multicenter, double-blind, 2×2 factorial randomized controlled trial is to evaluate the efficacy and safety of isosorbide mononitrate, butylphthalide, and their combination in reducing disability in patients with acute lacunar stroke.

Read the detailed description

There is an urgent need for effective therapeutic strategies for acute ischemic cerebral small vessel disease (CSVD). Isosorbide mononitrate and butylphthalide may exert protective effects; however, large-scale randomized controlled trials are required to confirm their efficacy and safety and to guide clinical practice.

In this study, patients presenting with a clinical lacunar syndrome within 7 days of onset will be randomly assigned, in a 1:1:1:1 ratio, to one of four groups in addition to routine care: (1) isosorbide mononitrate plus butylphthalide, (2) isosorbide mononitrate plus butylphthalide placebo, (3) isosorbide mononitrate placebo plus butylphthalide, or (4) isosorbide mononitrate placebo plus butylphthalide placebo. The treatment period will last 6 months, with a total follow-up of 1 year, including assessments at 7 days, 1 month, 3 months, 6 months, and 1 year.

The primary efficacy outcome is post-stroke disability at 6 months. The primary safety outcome is moderate or more severe headache within 6 months.

Being tested
Isosorbide Mononitrate, Butylphthalide, Isosorbide Mononitrate Placebo, Butylphthalide Placebo
Medical subject headings
Stroke, Lacunar, Ischemic Stroke, Cerebral Small Vessel Diseases

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Isosorbide MononitrateDrug

    Days 1-7: Isosorbide mononitrate injection, 20 mg once daily by intravenous infusion.

    Days 8-6 months: Isosorbide mononitrate sustained-release tablets, 40 mg once daily orally (dose reduced to 20 mg once daily during the final week).

  • ButylphthalideDrug

    Days 1-7: Butylphthalide injection, 25 mg twice daily by intravenous infusion.

    Days 8-6 months: Butylphthalide soft capsules, 200 mg three times daily orally.

  • Isosorbide Mononitrate PlaceboDrug

    Days 1-7: Isosorbide mononitrate injection placebo, once daily by intravenous infusion.

    Days 8-6 months: Isosorbide mononitrate sustained-release tablet placebo, once daily orally (dose reduced to half a tablet once daily during the final week).

  • Butylphthalide PlaceboDrug

    Days 1-7: Butylphthalide injection placebo, twice daily by intravenous infusion.

    Days 8-6 months: Butylphthalide soft capsule placebo, 2 capsules three times daily orally.

Study groups in NCT07252544
Study groupRoleWhat they receive
isosorbide mononitrate plus butylphthalideExperimentalNot described
Receives: Drug: Isosorbide Mononitrate; Drug: Butylphthalide
isosorbide mononitrate plus butylphthalide placeboExperimentalNot described
Receives: Drug: Isosorbide Mononitrate; Drug: Butylphthalide Placebo
isosorbide mononitrate placebo plus butylphthalideExperimentalNot described
Receives: Drug: Butylphthalide; Drug: Isosorbide Mononitrate Placebo
isosorbide mononitrate placebo plus butylphthalide placeboPlacebo comparatorNot described
Receives: Drug: Isosorbide Mononitrate Placebo; Drug: Butylphthalide Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Proportion of participants with post-stroke disability at 6 months

    A composite endpoint defined as the occurrence of any of the following: modified Rankin Scale (mRS) score ≥ 3, major adverse cardiovascular events (MACE), cognitive impairment, or all-cause mortality. The mRS measures post-stroke functional outcome on a scale from 0 (no symptoms) to 6 (death). MACE includes non-fatal stroke, non-fatal myocardial infarction (MI), and vascular death.The assessment of cognitive function involves three stages: a cognitive screening test, supplementary cognitive testing, and adjudication by an expert panel. The Beijing version of the Montreal Cognitive Assessment (MoCA) is used as the cognitive screening scale. Scores on the MoCA range from 0 to 30, with lower scores indicating greater cognitive impairment.The supplementary cognitive assessment includes the evaluation of several domains: executive function, attention and processing speed, language, and memory, as well as activities of daily living.

    Measured: 6 months

  2. Incidence of moderate or more severe headache within 6 months

    Headache severity is assessed using the Numerical Rating Scale (NRS), where: 0 indicates no pain; 1 represents a mild headache (including feelings of head pressure or throbbing that are not considered painful); a score of 4 or higher (≥4) represents a headache of at least moderate intensity; and 10 represents the worst headache imaginable to the subject.

    Measured: 6 months

Secondary outcomes (10)
  1. Proportion of participants with post-stroke disability at 1 year

    The difinition of post-stroke disability is the same as the primary outcome measure.

    Measured: 1 year

  2. Proportion of participants with the modified Rankin Scale (mRS) score ≥ 3 at 6 months and 1 year

    The modified Rankin Scale (mRS) is used to measure the degree of disability and dependence after a stroke. The scale ranges from 0 to 6. A score of 0 represents no symptoms, 1 represents no significant disability, 2 represents slight disability, 3 represents moderate disability, 4 represents moderately severe disability, 5 represents severe disability, and 6 represents death.

    Measured: 6 months and 1 year

  3. Incidence of recurrent stroke within 6 months and 1 year

    Measured: 6 months and 1 year

  4. Proportion of participants with dementia at 6 months and 1 year

    Dementia (all of the following criteria must be met):

    1. Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition) based on:1.Concern from the individual, a knowledgeable informant, or the clinician that there has been a significant decline in cognitive function. 2.A substantial impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment.
    2. The cognitive deficits interfere with independence in everyday activities (i.e., at a minimum, requiring assistance with complex instrumental activities of daily living, such as paying bills or managing medications).
    3. The cognitive deficits do not occur exclusively in the context of a delirium.
    4. The cognitive deficits are not better explained by another mental disorder.

    Measured: 6 months and 1 year

  5. National Institutes of Health Stroke Scale (NIHSS) scores at 7 days, 6 months, and 1 year (including changes from baseline)

    The National Institutes of Health Stroke Scale (NIHSS) is a standardized tool used to objectively measure the severity of a stroke by quantifying a patient's neurological deficits. Its primary purposes are to evaluate the acuity of a stroke, guide treatment decisions, and predict patient outcomes. The scale's total score ranges from 0 to 42, with higher scores representing more severe neurological impairment.

    Measured: baseline, 7 days, 6 months, and 1 year

  6. Incidence of hypotension within 6 months

    Hypotension is defined as a systolic blood pressure (SBP) of less than 100 mmHg or a 30% decrease from baseline.

    Measured: 6 months

  7. Incidence of syncope within 6 months

    Syncope is a transient loss of consciousness caused by transient global cerebral hypoperfusion, characterized by a rapid onset, short duration, and spontaneous, complete recovery.

    The diagnosis requires the following conditions to be met:

    1. A transient loss of consciousness with a rapid onset (from a few seconds to 1 minute);
    2. A short duration (from a few seconds to a few minutes);
    3. Spontaneous and complete recovery;
    4. Absence of focal neurological signs;
    5. Exclusion of head trauma and epileptic seizures.

    Measured: 6 months

  8. Incidence of liver function impairment within 6 months

    Liver function impairment may be diagnosed if at least one of the following criteria is met:

    1. Serum AST or ALT > 5 × the upper limit of normal (ULN), or ALP > 2 × ULN (or from an abnormal baseline value);
    2. Serum total bilirubin (TBil) > 2.5 mg/dL (42.75 μmol/L) accompanied by any elevation in serum AST, ALT, or ALP levels.

    Measured: 6 months

  9. Incidence of any bleeding within 6 months

    Bleeding events are evaluated using the GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) classification and categorized as severe, moderate, or mild.

    Measured: 6 months

  10. Incidence of symptomatic intracranial hemorrhage within 6 months

    According to the Heidelberg Bleeding Classification established at the 12th Thrombolytic Therapy in Acute Ischemic Stroke workshop in Germany in 2015, symptomatic intracerebral hemorrhage (sICH) is defined as meeting all of the following conditions:

    1. Any form of intracranial hemorrhage (including types 1a, 1b, 1c, 2, 3a, 3b, 3c, and 3d of the Heidelberg classification) that is detected by imaging (head CT or MRI) and confirmed by a radiologist;
    2. The patient experiences clinical deterioration, defined as: an increase in the NIHSS score of ≥ 4 points from the last score prior to deterioration, OR an increase of ≥ 2 points on any single item of the NIHSS, OR an outcome leading to tracheal intubation, decompressive craniectomy, ventricular drainage, or other major medical/surgical intervention;
    3. The clinical deterioration cannot be explained by any cause other than the intracranial hemorrhage.

    Measured: 6 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted26 Nov 2025
  2. Study start1 Dec 2025 (estimated)
  3. Primary completion31 Aug 2027 (estimated)
  4. Study completion29 Feb 2028 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Factorial
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
3,156 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07252544
Sponsor's protocol ID
2023ZD0504802
Status last verified
Sep 2025
First submitted
9 Sep 2025
Last updated
26 Nov 2025
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Isosorbide Mononitrate and Butylphthalide in people with Stroke, Lacunar and Stroke, Acute Ischemic, run by Beijing Tiantan Hospital.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 11 inclusion and 19 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 26 Nov 2025. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Ying Gao (+86 10 59976165, tjssgaoying@163.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Proportion of participants with post-stroke disability at 6 months (time frame: 6 months). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 26 Nov 2025.

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