Prevention of Femoropopliteal In-Stent Restenosis With Cilostazol

Iftikhar, Omer; Oliveros, Karla; Tafur, Alfonso; Casanegra, Ana I.

doi:10.1177/0003319715604768

Cited by 23 publications

(11 citation statements)

References 46 publications

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“…A meta-analysis suggested an association between cilostazol use and reduced rates of in-stent restenosis after FP stenting in "high-risk" patients, pooling studies that included 75% claudicants. 573 Conversely, an open label RCT found no effect of cilostazol treatment in reducing restenosis after IP interventions for severe limb ischemia. 574 No clear recommendation can be made at present regarding the potential benefit of cilostazol after endovascular interventions for CLTI.…”

Section: Research Prioritiesmentioning

confidence: 99%

Global vascular guidelines on the management of chronic limb-threatening ischemia

Conte

Bradbury

Kolh³

et al. 2019

Journal of Vascular Surgery

1,189

865

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Chronic limb-threatening ischemia (CLTI) is associated with mortality, amputation, and impaired quality of life. These Global Vascular Guidelines (GVG) are focused on definition, evaluation, and management of CLTI with the goals of improving evidence-based care and highlighting critical research needs. The term CLTI is preferred over critical limb ischemia, as the latter implies threshold values of impaired perfusion rather than a continuum. CLTI is a clinical syndrome defined by the presence of peripheral artery disease (PAD) in combination with rest pain, gangrene, or a lower limb ulceration >2 weeks duration. Venous, traumatic, embolic, and nonatherosclerotic etiologies are excluded. All patients with suspected CLTI should be referred urgently to a vascular specialist. Accurately staging the severity of limb threat is fundamental, and the Society for Vascular Surgery Threatened Limb Classification system, based on grading of Wounds, Ischemia, and foot Infection (WIfI) is endorsed. Objective hemodynamic testing, including toe pressures as the preferred measure, is required to assess CLTI. Evidence-based revascularization (EBR) hinges on three independent axes: Patient risk, Limb severity, and ANatomic complexity (PLAN). Average-risk and high-risk patients are defined by estimated procedural and 2-year all-cause mortality. The GVG proposes a new Global Anatomic Staging System (GLASS), which involves defining a preferred target artery path (TAP) and then estimating limb-based patency (LBP), resulting in three stages of complexity for intervention. The optimal revascularization strategy is also influenced by the availability of autogenous vein for open bypass surgery. Recommendations for EBR are based on best available data, pending level 1 evidence from ongoing trials. Vein bypass may be preferred for average-risk patients with advanced limb threat and high complexity disease, while those with less complex anatomy, intermediate severity limb threat, or high patient risk may be favored for endovascular intervention. All patients with CLTI should be afforded best medical therapy including the use of antithrombotic, lipid-lowering, antihypertensive, and glycemic control agents, as well as counseling on smoking cessation, diet, exercise, and preventive foot care. Following EBR, long-term limb surveillance is advised. The effectiveness of nonrevascularization therapies (eg, spinal stimulation, pneumatic compression, prostanoids, and hyperbaric oxygen) has not been established. Regenerative medicine approaches (eg, cell, gene therapies) for CLTI should be restricted to rigorously conducted randomizsed clinical trials. The GVG promotes standardization of study designs and end points for clinical trials in CLTI. The importance of multidisciplinary teams and centers of excellence for amputation prevention is stressed as a key health system initiative.

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Section: Research Prioritiesmentioning

confidence: 99%

Global vascular guidelines on the management of chronic limb-threatening ischemia

Conte

Bradbury

Kolh³

et al. 2019

Journal of Vascular Surgery

1,189

865

View full text Add to dashboard Cite

show abstract

“…99 Similarly, a meta-analysis of four studies, with each study including mostly patients with claudication (approximately 75%), showed that cilostazol was associated with reduced in-stent restenosis rates after femoropopliteal stenting. 100 Therefore, cilostazol has been recommended as guideline-directed therapy for PAD. 101…”

Section: Antithrombotic Therapymentioning

confidence: 99%

Medical therapy for cardiovascular and limb-related risk reduction in critical limb ischemia

Giannopoulos

Armstrong

2021

Vasc Med

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Critical limb ischemia (CLI) constitutes the most advanced form of peripheral artery disease (PAD) and is characterized by ischemic rest pain, tissue loss and/or gangrene. Optimized medical care and risk factor modification in addition to revascularization could reduce the incidence of cardiovascular events and major adverse limb events, improving patients’ quality of life and promising higher survival rates. Adequate adherence to cardioprotective medications, including antithrombotic therapy (e.g. antiplatelets, anticoagulants), cholesterol-lowering agents (e.g. statins, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors), angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), and smoking cessation should be strongly encouraged for patients with CLI. This review examines these guideline-recommended therapies in terms of cardiovascular and limb-related risk reduction in patients with CLI.

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“…35,52,53 Our results are consistent with the results of prior metaanalyses including improved primary patency and lower TLR with cilostazol. [54][55][56] However, unlike previous analyses, we excluded studies that compared cilostazol with ticlopidine, which is no longer used. In our analysis, we included studies that compared cilostazol versus no cilostazol regardless of the use of clopidogrel or oral anticoagulants.…”

Section: Discussionmentioning

confidence: 99%

Outcomes with cilostazol after endovascular therapy of peripheral artery disease

et al. 2019

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The role of cilostazol after endovascular therapy (EVT) of peripheral artery disease (PAD) remains unclear. We conducted a meta-analysis for all studies reporting the outcomes of cilostazol after EVT of PAD from January 2000 through November 2018 with the outcomes of interest including primary patency, major adverse limb events (MALE), target lesion revascularization (TLR), and major amputation. We included eight studies (three randomized controlled trials (RCTs) and five observational studies) with a total of 3846 patients (4713 lesions). During a mean follow-up duration of 12.5 ± 5 months, the use of cilostazol was associated with higher primary patency (OR 2.28, 95% CI (1.77, 2.94), p < 0.001, I2 = 24%), lower risk of TLR (OR 0.37, 95% CI (0.26, 0.52), p < 0.001, I2 = 0%), and lower risk of major amputation (OR 0.15, 95% CI (0.04, 0.62), p = 0.008, I2 = 0%). The use of cilostazol in RCTs was associated with significantly higher odds of primary patency compared with observational studies (OR 3.37 vs 2.28, p-interaction = 0.03). After further subgroup analysis, cilostazol remained associated with higher primary patency regardless of the use of anticoagulants (warfarin) ( p-interaction = 0.49). We conclude that the use of cilostazol after EVT of femoropopliteal and iliac lesions is associated with improved primary patency and lower risk of major amputation and TLR. The favorable impact of cilostazol is independent of the use of warfarin. PROSPERO identifier: CRD42018092715.

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Prevention of Femoropopliteal In-Stent Restenosis With Cilostazol

Cited by 23 publications

References 46 publications

Global vascular guidelines on the management of chronic limb-threatening ischemia

Global vascular guidelines on the management of chronic limb-threatening ischemia

Medical therapy for cardiovascular and limb-related risk reduction in critical limb ischemia

Outcomes with cilostazol after endovascular therapy of peripheral artery disease

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