Drug-Eluting Stenting Followed by Cilostazol Treatment Reduces Late Restenosis in Patients With Diabetes Mellitus

Lee, Seung Whan; Park, Seong Wook; Kim, Young Hak; Yun, Sung Cheol; Park, Duk‐Woo; Lee, Cheol Whan; Hong, Myeong Ki; Kim, Hyun Sook; Ko, Jung Ho; Park, Jae‐Hyeong; Lee, Jae‐Hwan; Choi, Si Wan; Seong, In Whan; Cho, Yoon Haeng; Lee, Nae Hee; Kim, June Hong; Chun, Kook Jin; Park, Seung Jung

doi:10.1016/j.jacc.2007.11.049

Cited by 193 publications

(72 citation statements)

References 12 publications

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“…A total of 14 trials (13 published in peer-review journals and 1 published online) [9,11,12,13,14,15,16,17,18,19,20,21,22,23] with 5,821 patients were identified from 394 potentially relevant publications.…”

Section: Resultsmentioning

confidence: 99%

“…Table 1 summarizes the baseline characteristics and risk of bias of 13 trials [9,11,12,13,14,15,16,17,18,19,20,21,22] reported in full-text publication. It was comparable between each arm in patient demographics, lesion (location, classification and length) and stent characteristics (type, length and diameter), risk factors (hypertension, hyperlipidemia, diabetes and smoking) and baseline regimens (statins, β-blocker, angiotensin converting enzyme inhibitor, aspirin and ticlopidine/clopidogrel), except for more lesions in the left anterior descending artery in the TAT group in the CREST trial [11] and more frequent usage of angiotensin-converting enzyme inhibitors in the DAT group in the CILON-T trial [9].…”

Section: Resultsmentioning

confidence: 99%

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Cilostazol-Based Triple Antiplatelet Therapy Compared to Dual Antiplatelet Therapy in Patients with Coronary Stent Implantation: A Meta-Analysis of 5,821 Patients

et al. 2012

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Background: Uncertainties still remain in terms of what kinds of patients benefit most from cilostazol-based triple antiplatelet therapy (TAT) after coronary stenting. Methods: We performed a meta-analysis of all relevant randomized controlled trials (RCTs) to investigate the effect of TAT versus dual antiplatelet therapy (DAT) in terms of major adverse cardiovascular events (MACEs) in patients undergoing coronary stenting. Results: Fourteen RCTs with 5,821 patients were included in this study. TAT was associated with a significant reduction in the risk of MACEs compared to DAT [9.2 vs. 13.4%; odds ratio 0.59 (0.46, 0.76)] with consistent benefits among patients with diabetes, long lesions and small vessels. There were no significant between-group differences in the risk of cardiac death, myocardial infarction, stent thrombosis and bleeding events; however, the risk of target lesion revascularization was significantly lower in the TAT group. TAT resulted in borderline significant reduction in the risk of cardiovascular thrombotic events in unselected patients and significant decrease in patients with acute coronary syndrome [odds ratio 0.51 (0.27, 0.94)]. Conclusion: Under the treatment of standard DAT, the addition of cilostazol is an effective and relatively safe strategy in preventing MACEs after coronary stenting, especially for patients at high risk of restenosis or clinical events.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Cilostazol-Based Triple Antiplatelet Therapy Compared to Dual Antiplatelet Therapy in Patients with Coronary Stent Implantation: A Meta-Analysis of 5,821 Patients

et al. 2012

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“…It has a unique suppressive effect on the proliferation of vascular smooth muscle, as shown by its reduction of intimal hyperplasia and restenosis in patients after coronary intervention [61]. Especially in drug-eluting stents, triple antiplatelet therapy with cilostazol, aspirin, and clopidogrel decreased angiographic restenosis, resulting in a reduced risk of target lesion revascularization compared with DAPT in diabetic patients [62] or in drug-eluting stent implantation for long coronary lesions [63]. A preventive effect of cilostazol on restenosis is similarly recognized after CAS [64,65], so these results suggest that cilostazol may be a treatment option as perioperative antiplatelet therapy for CAS.…”

Section: Which Antiplatelet Agents Are Better For Cas?mentioning

confidence: 99%

Antiplatelet Therapy for Carotid Artery Stenting

Enomoto

Yoshimura²

2012

Intervent Neurol

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Carotid artery stenting (CAS) is less invasive and has a lower incidence of systemic complications such as myocardial infarction compared with carotid endarterectomy. However, CAS is known to have a high incidence of ischemic complications due to distal thromboembolism. Progress has been made in the development of various distal protection devices and protection methods aimed at preventing thromboembolism. Similar to these methods, perioperative antiplatelet therapy is also able to play a very important role in the prevention of ischemic events. Dual antiplatelet therapy has become standard for perioperative management of CAS.

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“…17) A similar result was demonstrated in another study documenting that triple therapy (aspirin, clopidogrel, and cilostazol) reduced in-segment restenosis by 50% compared to dual therapy (aspirin plus clopidogrel) in diabetic patients. 18) In long lesions, cilostazol reduced late in-stent and in-segment loss and reduced the occurrence of target-vessel revascularization at 6 months after DES implantation. 19) Furthermore, cilostazol treatment changed in-stent restenosis morphology to a more focal pattern compared to that seen in clopidogrel-treated patients.…”

Section: Clinical Trials and Evidence For Clinical Effectsmentioning

confidence: 98%

The Clinical Effects of Cilostazol on Atherosclerotic Vascular Disease

Park

Kim

2008

Korean Circ J

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Cilostazol inhibits phosphodiesterase III (PDE III), which is predominantly distributed to and regulates physiologic responses in platelets, cardiac muscle cells, vascular smooth muscle cells, and adipose cells. Clinically, it is well known as an antiplatelet agent that inhibits the platelet aggregation normally induced by collagen, 5'-adenosine diphosphase (ADP), epinephrine, and arachidonic acid. It also has pleotropic effects, including the prevention of restenosis after angioplasty and the promotion of peripheral vascular flow in patients with peripheral vascular diseases. In the drug-eluting stent era, it has emerged as an effective post-intervention anti-atherothrombotic agent and a useful agent for therapy in diabetic patients. The aim of this study was to review the mechanisms of action and clinical trial results associated with cilostazol in cardiovascular disease patients.

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Drug-Eluting Stenting Followed by Cilostazol Treatment Reduces Late Restenosis in Patients With Diabetes Mellitus

Abstract: Triple antiplatelet therapy after DES implantation decreased angiographic restenosis and extent of late loss, resulting in a reduced risk of 9-month TLR compared with dual antiplatelet therapy in diabetic patients.

Cited by 193 publications

References 12 publications

Cilostazol-Based Triple Antiplatelet Therapy Compared to Dual Antiplatelet Therapy in Patients with Coronary Stent Implantation: A Meta-Analysis of 5,821 Patients

Cilostazol-Based Triple Antiplatelet Therapy Compared to Dual Antiplatelet Therapy in Patients with Coronary Stent Implantation: A Meta-Analysis of 5,821 Patients

Antiplatelet Therapy for Carotid Artery Stenting

The Clinical Effects of Cilostazol on Atherosclerotic Vascular Disease

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