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Cilostazol decreases in-stent restenosis rates after carotid artery stenting
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Use of cilostazol after carotid artery stenting was associated with a decrease in in-stent restenosis rates, according to a new meta-analysis.
Researchers analyzed seven studies of 1,297 patients who underwent carotid artery stenting.
Outcomes of interest included in-stent restenosis during the study period, revascularization rate, major and minor bleeding and rate of MI, stroke or death at 30 days and during the observation period.
George Galyfos, MD, PhD, from the first department of propaedeutic surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece, and colleagues found that among the 1,233 patients from the six studies for which in-stent restenosis was an endpoint (mean follow-up, 20 months), use of cilostazol was associated with a lower rate of in-stent restenosis (OR = 0.158; 95% CI, 0.072-0.349).
Five studies covering 649 patients had an endpoint of MI, stroke or death at 30 days. Cilostazol did not significantly impact that outcome (OR = 0.724; 95% CI, 0.293-1.789).
In the three studies of 1,076 period that had an endpoint of MI, stroke or death during the entire follow-up period, use of cilostazol did not affect the outcome (OR = 0.768; 95% CI, 0.477-1.236), according to the researchers.
Data on rates of bleeding and revascularization were not adequate enough to conduct a pooled analysis, Galyfos and colleagues wrote.
“The main mechanism for cilostazol-mediated decrease in restenosis is likely the inhibition of intimal hyperplasia,” they wrote. “Cilostazol decreases thromboxane formation by enhancement of the platelet/cAMP level, leading to a pleiotropic action that includes inhibition of platelet aggregation and vasodilation, vascular smooth muscle cell differentiation, an increase in heart rate and contractile force and an improvement in lipid metabolism.”
Only one of the studies in the meta-analysis was randomized, and more randomized trials are needed, they wrote. – by Erik Swain
Disclosure: The researchers report no relevant financial disclosures.
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