title: Continuous daily use of cilostazol prevents in-stent restenosis following carotid artery stenting: serial angiographic investigation of 229 lesions.
abstract: BACKGROUND
  Several studies have reported that cilostazol (CLS) may reduce in-stent restenosis (ISR) after carotid artery stenting (CAS). However, it is not known for how long CLS must be continued to prevent ISR.
  
  
  METHODS
  We retrospectively reviewed a prospectively collected database of patients who underwent elective CAS and follow-up angiography at 3 months and 1 year after the procedure. ISR was defined as stenosis of 50% or greater on digital subtraction angiography. The cumulative incidence rates of angiographic ISR were compared between the three groups, divided according to duration of CLS use : (1) patients who were maintained on CLS for 12 months or more after CAS (12M CLS group, n=70), (2) patients who were treated with CLS for the first 3 months after CAS (3M CLS group, n=23), and (3) patients who did not receive CLS (no CLS group, n=136).
  
  
  RESULTS
  A total of 229 lesions in 199 patients were included in our analysis. During a median follow-up of 365 days, ISR was detected in 15 lesions. The cumulative ISR rates overall and in the 12M CLS, 3M CLS, and no CLS groups were 5.6%, 0%, 5.0%, and 8.4%, respectively, at 1 year, and the log rank test showed that there was a significant difference between the three groups (p<0.05). Cox regression analysis demonstrated that the 12M CLS group had a significantly lower risk of ISR than the 3M CLS group (adjusted relative risk (aRR) 3.06e-10, 95% CI 0 to 0.51, p<0.05) and the no CLS group (aRR 1.41e-10, 95% CI 0 to 0.15, p<0.001), whereas no difference was found between the 3M CLS group and the no CLS group.
  
  
  CONCLUSIONS
  An overall cumulative ISR rate of 5.6% was documented angiographically at 1 year after CAS. Continuous daily use of CLS (for at least 1 year) may have a beneficial effect on long term prevention of ISR.
authors.affiliation: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Miyazaki
authors.affiliation: Department of Stroke Treatment, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Mori
authors.affiliation: Department of Stroke Treatment, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Iwata
authors.affiliation: Department of Stroke Treatment, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Aoyagi
authors.affiliation: Department of Stroke Treatment, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan.
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Tanno
authors.affiliation: Department of Stroke Treatment, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan.
authors.forename: Shigen
authors.initials: S
authors.lastname: Kasakura
authors.affiliation: Department of Stroke Treatment, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yoshioka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods* / Q000639:trends; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D000077407:Cilostazol; D004334:Drug Administration Schedule; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D015607:Stents; D013777:Tetrazoles / Q000008:administration & dosage*
chemical_list: D005343:Fibrinolytic Agents; D013777:Tetrazoles; D000077407:Cilostazol
keywords: Angiography; Cervical; Drug; Stent