title: Efficacy of cilostazol in prevention of bradycardia during carotid artery stenting.
abstract: BACKGROUND
  Hypotension and bradycardia are known to occur frequently in carotid artery stenting (CAS), which may lead to postprocedural complications. The purpose of this retrospective study was to assess the efficacy of cilostazol, a phosphodiesterase 3 inhibitor, for preventing bradycardia and hypotension in the periprocedural period.
  
  
  METHODS
  The study population comprised 53 patients (54 lesions) with carotid artery stenosis who underwent CAS at our institution between 2004 and 2008. The patients were categorized by the use (group C, n = 26) or nonuse of cilostazol (group N, n = 28). The incidences of intraprocedural and postprocedural hypotension and bradycardia in each group were statistically assessed.
  
  
  RESULTS
  Intraprocedural hypotension and bradycardia occurred in 9 cases (34.6%) and 4 cases (15.3%) in group C and in 5 cases (17.9%) and 15 cases (53.6%) in group N, respectively. Postprocedural hypotension and bradycardia occurred in 4 cases (15.4%) and 0 cases in group C and in 1 case (3.6%) and 3 cases (10.7%) in group N, respectively. The incidence of intraprocedural bradycardia (IBc) was significantly lower in group C (P = .0035). Logistic regression analysis revealed that the use of cilostazol decreased the risk of IBc 99.5% (odds ratio [OR] = .01, 95% confidence interval [CI]: 5.46 × 10(-6) to .04, P = .001) and distance from carotid bifurcation to maximum stenotic lesion was independently associated with IBc (OR = .46, 95% CI: .29-.74, P = .001).
  
  
  CONCLUSIONS
  Use of cilostazol was associated with a lower incidence of IBc. Cilostazol may be a useful drug for the prevention of this complication.
authors.affiliation: Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. Electronic address: zokun@xd6.so-net.ne.jp.
authors.forename: Daizo
authors.initials: D
authors.lastname: Ishii
authors.affiliation: Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Tetsu
authors.initials: T
authors.lastname: Satow
authors.affiliation: Department of Neuroendovascular Therapy, Shiroyama Hospital, Osaka, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Murao
authors.affiliation: Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Nishimura
authors.affiliation: Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Iihara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001919:Bradycardia / Q000209:etiology / Q000517:prevention & control*; D002339:Carotid Arteries / Q000601:surgery*; D000077407:Cilostazol; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D015607:Stents; D013777:Tetrazoles / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D014665:Vasodilator Agents; D000077407:Cilostazol
keywords: Bradycardia; carotid artery stenting; cilostazol; hypotension