title: Cilostazol reduces restenosis after carotid artery stenting.
abstract: BACKGROUND
  Although carotid artery stenting (CAS) has been proposed as an alternative to carotid endarterectomy in cerebral revascularization, restenosis remains an unsolved issue. Cilostazol is a unique antiplatelet drug that has vasodilatory effects and inhibits smooth muscle cell proliferation. We investigated whether cilostazol reduces restenosis after CAS.
  
  
  METHODS
  A database of 113 consecutive CAS procedures between April 2002 and December 2007 was assessed retrospectively. All patients received aspirin (100 mg/d) and another antiplatelet drug such as cilostazol (200 mg/d), ticlopidine (200 mg/d), or clopidogrel (75 mg/d) at least 3 days before CAS. Two antiplatelet drugs were continued for 2 to 3 months after CAS and reduced to one thereafter. Patients were evaluated at 3 and 6 months and at 6-month intervals thereafter with duplex ultrasound (DUS) imaging. Angiography was used for confirmation when stenosis was suspected as >50% with DUS imaging.
  
  
  RESULTS
  We were able to monitor 97 patients for a 12-month period. The overall combined rate of stroke, myocardial infarction, and death was 3.1% at 30 days and 4.1% at 1 year. In-stent recurrent stenosis was documented in 11 patients (11%); in 10 patients (9.7%), this occurred <or=12 months of CAS. In-stent restenosis was significantly reduced in the cilostazol (+) group (0% vs 15.7% [11 of 70], P = .03). Patient characteristics were similar between the cilostazol (+) and cilostazol (-) groups.
  
  
  CONCLUSIONS
  Although this study was retrospective and nonrandomized, the results suggest that cilostazol administration improves long-term patency after CAS due to its inhibitory effect on smooth muscle cell growth.
authors.affiliation: Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan. t-tomojy@mx2.harmonix.ne.jp
authors.forename: Tomoji
authors.initials: T
authors.lastname: Takigawa
authors.forename: Yuji
authors.initials: Y
authors.lastname: Matsumaru
authors.forename: Mikito
authors.initials: M
authors.lastname: Hayakawa
authors.forename: Shigeru
authors.initials: S
authors.lastname: Nemoto
authors.forename: Akira
authors.initials: A
authors.lastname: Matsumura
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D000077407:Cilostazol; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D055502:Secondary Prevention; D015607:Stents; D020521:Stroke / Q000209:etiology; D013777:Tetrazoles / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex
chemical_list: D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D000077407:Cilostazol