Keywords:
Interventional vascular, CNS, Catheter arteriography, CT-Angiography, Stents, Comparative studies, Arteriosclerosis, Drugs / Reactions
Authors:
J. Kashiwagi1, H. Kiyosue1, I. Nakahara2, Y. Suenaga1, M. Hirohata3, Y. Hori4, M. Okahara5, S. Tanoue1, H. Mori4; 1Yufu/JP, 2Kitakyushu/JP, 3Kurume/JP, 4Oita/JP, 5Beppu/JP
DOI:
10.1594/ecr2013/C-2562
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 in part be attributable to different definitions of the duplex criteria of a restenosis during follow-up investigations [2,3].
Therefore,
the current study had a major aim to investigate the incidence of restenosis,
to analyze clinical predictors for restenosis in order to identify patients at greatest risk who are expected to benefit from a rigorous follow-up.
The 2011 ASA/ ACCF/ AHA/ AANN/ AANS/ ACR/ ASNR/ CNS/ SAIP/ SCAI/ SIR/ SNIS/ SVM/ SVS guideline [4] recommended dual-antiplatelet therapy with aspirin (81 to 325 mg daily) plus clopidogrel (75 mg daily) before and for a minimum of 30 days after CAS.
However,
there was no recommendation after 30 days and no comment on aspirin resistance and clopodogrel resistance both of which had occurred with a fixed probability [5].
Furthermore,
the type of therapy and the administration period have not been established.
Many studies performed to evaluate drug efficacy after stent placement in the extracranial carotid arteries have used thienopyridine drugs (e.g.,
clopidogrel 75 mg/day) administered for 1-3 months as postoperative antiplatelet therapy in addition to lifetime aspirin administration.
It has also been reported that cilostazol can prevent restenosis and revascularization [6-8]; however,
the type of patients that may benefit from cilostazol and the appropriate period of administration have not been determined.
In this study,
we examined the efficacy of cilostazol after placement of a self-expandable stent in the extracranial carotid arteries.