Purpose
Clinical long-term outcomes of carotid artery stenting (CAS) are sparse and controversially discussed [1].
This is especially the occurrence of restenosis could endanger the long-term efficacy and safety of CAS.
Considering the fact that to date there is no established treatment strategy for a restenosis,
this issue will be of high clinical importance particularly if patients <70 years are preferably being treated with CAS in the future.
By now,
the exact rate and clinical impact of restenosis during long-term follow-up is still unclear,
which may...
Methods and Materials
Study Design
The study was performed as a multicenter,
prospective,
randomized,
and open-label trial.
Between September 2009 and November 2012,
118 patients were enrolled of whom 98 patients followed for over 6 months after CAS were selected in this study.
Cases that were treated by angioplasty alone,
used balloon-expandable stents,
had an acute onset of carotid occlusion,
had congestive heart failure,
had been deployed with drug-eluting stents for coronary arteries,
were in any stage of hemorrhage,
or had non-atherosclerotic stenoses were excluded.
In cases in...
Results
The binary restenosis rate tended to be slightly lower in the cilostazol group than in the non-cilostazol group.
(4.0% vs.
14.5%,
p=0.08).
The retreatment rate also tended to be lower in the cilostazol group than in the non-cilostazol group (4.0% vs.
8.3%,
p=0.43) (Table 2).
Cilostazol was effective for preventing intimal hyperplasia at 6-month follow-up in cases using open-cell type stents.
The mean thickness of intimal hyperplasia was significantly lower in the cilostazol group (0.43mm ± 0.38) than in the non-cilostazol group (0.99mm ± 0.54)...
Conclusion
The results of this study would show that cilostazol is effective for the prevention of restenosis and intimal hyperplasia after placement of a self-expandable stent in the carotid artery.
Cilostazol has been reported to be effective for the prevention of restenosis after stent placement in the coronary [9,10],
superficial femoral [11],
and carotid [6,7] arteries.
There are several possible mechanisms to explain the reduction of restenosis after CAS.
Cilostazol has a comparable inhibiting platelet aggregation effect [12,13] and it has a more rapid effect after...
References
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Economopoulos KP,
Sergentanis TN,
Tsivgoulis G,
et al.
Carotid artery stenting versus carotid endarterectomy: a comprehensive meta-analysis of short-term and long-term outcomes.
Stroke 2011; 42:687–692.
2.
Gro¨schel K,
Riecker A,
Schulz JB,
et al.
Systematic review of early recurrent stenosis after carotid angioplasty and stenting.
Stroke 2005; 36:367–373.
3.
Nederkoorn PJ,
Brown MM.
Optimal cut-off criteria for duplex ultrasound for the diagnosis of restenosis in stented carotid arteries: review and protocol for a diagnostic study.
BMC Neurol 2009; 9:36.
4.
Brott TG,
Halperin JL,...