title: Meta-Analysis of Studies Evaluating the Effect of Cilostazol on Major Outcomes After Carotid Stenting.
abstract: OBJECTIVE
  To evaluate the effect of cilostazol on major outcomes after carotid artery stenting (CAS).
  
  
  METHODS
  A systematic literature review was conducted conforming to established criteria in order to identify articles published prior to May 2015 evaluating major post-CAS outcomes in patients treated with cilostazol vs patients not treated with cilostazol. Major outcomes included in-stent restenosis (ISR) within the observation period, the revascularization rate, major/minor bleeding, and the myocardial infarction/stroke/death rate (MI/stroke/death) at 30 days and within the observation period. Data were pooled for all studies containing adequate data for each outcome investigated; effect estimates are presented as the odds ratios (ORs) and 95 confidence intervals (CI).
  
  
  RESULTS
  Overall, 7 studies pertaining to 1297 patients were eligible. Heterogeneity was low among studies so a fixed-effect analysis was conducted. Six studies (n=1233) were compared for the ISR endpoint, showing a significantly lower ISR rate with cilostazol treatment after a mean follow-up of 20 months (OR 0.158, 95% CI 0.072 to 0.349, p<0.001). Five studies (n=649) were compared regarding 30-day MI/stroke/death (OR 0.724, 95% CI 0.293 to 1.789, p=0.484) and 3 studies (n=1076) were analyzed regarding MI/stroke/death within the entire follow-up period (OR 0.768, 95% CI 0.477 to 1.236, p=0.276); no significant difference was found between the groups. Data on bleeding rates and revascularization rates post ISR were inadequate to conduct further analysis.
  
  
  CONCLUSIONS
  Cilostazol seems to decrease total ISR rates in patients undergoing CAS without affecting MI/stroke/death events, both in the early and late settings.
authors.affiliation: First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece Department of Vascular Surgery, KAT General Hospital, Athens, Greece georgegalyfos@hotmail.com.
authors.forename: George
authors.initials: G
authors.lastname: Galyfos
authors.affiliation: Department of Vascular Surgery, KAT General Hospital, Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Geropapas
authors.affiliation: First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
authors.forename: Fragiska
authors.initials: F
authors.lastname: Sigala
authors.affiliation: First Department of Cardiology, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
authors.forename: Konstantina
authors.initials: K
authors.lastname: Aggeli
authors.affiliation: Department of Microbiology, University of Athens Medical School, Areteion Hospital, Athens, Greece.
authors.forename: Argiri
authors.initials: A
authors.lastname: Sianou
authors.affiliation: First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Filis
mesh_terms: D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016009:Chi-Square Distribution; D000077407:Cilostazol; D006801:Humans; D009203:Myocardial Infarction / Q000209:etiology; D016017:Odds Ratio; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000209:etiology; D013777:Tetrazoles / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D013777:Tetrazoles; D000077407:Cilostazol
keywords: carotid artery stenosis; carotid artery stenting; cilostazol; complications; in-stent restenosis