Cilostazol reduces restenosis after carotid artery stenting

Takigawa, Tomohiro; Matsumaru, Yuji; Hayakawa, Masayuki; Nemoto, Shigeru; Matsumura, Akira

doi:10.1016/j.jvs.2009.08.040

Cited by 51 publications

(43 citation statements)

References 37 publications

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“…Regarding clinical events post CAS, data were adequate for comparison in only 5 trials 16,17,19,21,22 for 30-day outcomes and in 4 trials [17][18][19]21 for outcomes during the followup period. As no heterogeneity was identified, fixed-effect models were utilized.…”

Section: Resultsmentioning

confidence: 99%

“…Regarding major/minor bleeding, 3 of the studies 17,20,21 did not report any result and 2 studies 16,22 reported null bleeding events after CAS. Only one study 19 reported 7 bleedings overall (6 access site hematomas and 1 hemorrhage due to Regarding the revascularization rate post ISR, only 3 studies 18,19,22 reported a pooled rate of 33 endovascular treatments in 51 cases of ISR (65%) without stratifying the results according to antiplatelet treatment.…”

Section: Resultsmentioning

confidence: 99%

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Meta-Analysis of Studies Evaluating the Effect of Cilostazol on Major Outcomes After Carotid Stenting

et al. 2015

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Purpose: To evaluate the effect of cilostazol on major outcomes after carotid artery stenting (CAS). Methods: A systematic literature review was conducted conforming to established criteria in order to identify articles published prior to May 2015 evaluating major post-CAS outcomes in patients treated with cilostazol vs patients not treated with cilostazol. Major outcomes included in-stent restenosis (ISR) within the observation period, the revascularization rate, major/minor bleeding, and the myocardial infarction/stroke/death rate (MI/stroke/death) at 30 days and within the observation period. Data were pooled for all studies containing adequate data for each outcome investigated; effect estimates are presented as the odds ratios (ORs) and 95 confidence intervals (CI). Results: Overall, 7 studies pertaining to 1297 patients were eligible. Heterogeneity was low among studies so a fixed-effect analysis was conducted. Six studies (n=1233) were compared for the ISR endpoint, showing a significantly lower ISR rate with cilostazol treatment after a mean follow-up of 20 months (OR 0.158, 95% CI 0.072 to 0.349, p<0.001). Five studies (n=649) were compared regarding 30-day MI/stroke/death (OR 0.724, 95% CI 0.293 to 1.789, p=0.484) and 3 studies (n=1076) were analyzed regarding MI/stroke/death within the entire followup period (OR 0.768, 95% CI 0.477 to 1.236, p=0.276); no significant difference was found between the groups. Data on bleeding rates and revascularization rates post ISR were inadequate to conduct further analysis. Conclusion: Cilostazol seems to decrease total ISR rates in patients undergoing CAS without affecting MI/stroke/death events, both in the early and late settings.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Meta-Analysis of Studies Evaluating the Effect of Cilostazol on Major Outcomes After Carotid Stenting

et al. 2015

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“…Takigawa et al 7 reported a comparison of a group using CLZ (27 patients) and a group not using CLZ (70 patients) after CAS; the restenosis rate was 15.7% in the non-CLZ group with no restenosis in the CLZ group, showing a significantly greater reduction in restenosis in the CLZ group. Several different kinds of stents were used in this study.…”

Section: Discussionmentioning

confidence: 99%

“…6 Differences in stent design and procedure appear to affect the incidence of stenosis, and the antiplatelet agent CLZ has also been reported to inhibit restenosis. 7 The aim of this study was to investigate the frequency of restenosis and the effect of CLZ in preventing such restenosis after CAS by the standard procedure using the CWS (Boston Scientific, Natick, Massachusetts).…”

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confidence: 99%

Effect of Cilostazol in Preventing Restenosis after Carotid Artery Stenting Using the Carotid Wallstent: A Multicenter Retrospective Study

Takayama

Taoka

Nakagawa

et al. 2012

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Restenosis after CAS is a postoperative problem, with a reported frequency of approximately 2%-8%. However differences in stent design, procedure, and the antiplatelet agent appear to affect the incidence of restenosis. We assessed the frequency of restenosis and the effect of the antiplatelet agent CLZ in preventing restenosis after CAS by the standard procedure using the CWS.

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“…Cilostazol has the potential to reduce the rate of ISR after PCI 7,29) and CAS. 28,31) In this study, none of our cilostazol-treated patients manifested ISR on follow-up angiograms obtained at a mean of 5.4 months after CAS. By inhibiting the cell cycle progression of vascular smooth muscle cells (VSMC), cilostazol exerts a direct negative effect on VSMC proliferation.…”

Section: Discussionmentioning

confidence: 60%

Cilostazol Reduces Periprocedural Hemodynamic Depression in Carotid Artery Stenting

Tsutsumi

Aikawa

Nii

et al. 2013

Neurol. Med. Chir.(Tokyo)

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The clinical effects of two different types of antiplatelet drugs, cilostazol and thienopyridine drugs, were compared in patients treated by carotid artery stenting (CAS). Two hundred patients scheduled for CAS were randomized to either cilostazol or a thienopyridine drug (ticlopidine or clopidogrel). The study was conducted in open-label design. Aspirin was also given to all patients. All episodes of periprocedural hemodynamic instability (bradycardia, hypotension) were recorded together with all instances of stroke, cardiac morbidity, and death within 30 days of the procedure. Angiographic followup studies were conducted about 6 months after CAS. Finally, 197 patients were enrolled in this study; 97 were treated with cilostazol (cilostazol group) and 100 with a thienopyridine drug (thienopyridine group). In the 30-day follow-up period, the incidence of stroke, cardiac adverse effects, and death was not significantly different between the 2 groups (cilostazol group 7.2%, thienopyridine group 11.0%; p ＝ 0.85). The incidence of intra-and postprocedural bradycardia was significantly lower in the cilostazol group (cilostazol group 18.6% and 2.1%, thienopyridine group 40.0% and 18.0%, respectively; p º 0.01). Although the incidence of intraprocedural hypotension did not significantly differ between the 2 groups, postprocedural hypotension was significantly lower in the cilostazol group (16.5% vs. 34.0%, p º 0.01). In-stent restenosis on follow-up angiograms was lower in the cilostazol group but not significantly (0% vs. 4.4%, p ＝ 0.12). This small open-label study shows that cilostazol may reduce periprocedural bradycardia and hypotension compared with thienopyridine drugs in patients treated by CAS.

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Cilostazol reduces restenosis after carotid artery stenting

Abstract: Although this study was retrospective and nonrandomized, the results suggest that cilostazol administration improves long-term patency after CAS due to its inhibitory effect on smooth muscle cell growth.

Cited by 51 publications

References 37 publications

Meta-Analysis of Studies Evaluating the Effect of Cilostazol on Major Outcomes After Carotid Stenting

Meta-Analysis of Studies Evaluating the Effect of Cilostazol on Major Outcomes After Carotid Stenting

Effect of Cilostazol in Preventing Restenosis after Carotid Artery Stenting Using the Carotid Wallstent: A Multicenter Retrospective Study

Cilostazol Reduces Periprocedural Hemodynamic Depression in Carotid Artery Stenting

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