Meta-Analysis of Studies Evaluating the Effect of Cilostazol on Major Outcomes After Carotid Stenting

Abstract

Purpose: 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 followup 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. Conclusion: Cilostazol seems to decrease total ISR rates in patients undergoing CAS without affecting MI/stroke/death events, both in the early and late settings.

Restenosis after Coronary and Peripheral Intervention: Efficacy and Clinical Impact of Cilostazol

“…A recent meta-analysis with a systemic review of clinical studiesdthat evaluated the effects of a cilostazol treatment after a carotid stent implantation for the treatment of asymptomatic or symptomatic stenosisdincluded 7 controlled trials (only 1 randomized trial) for a total of 1,297 patients. 12 Meta-analysis results showed a significantly lower in-stent restenosis rate in the patients treated with cilostazol after a mean 20-month follow-up: risk À85%, P < 0.001. Instead, the pooled incidence of infarction, stroke, and death at 1-and 20-month follow-up suggests a statistically not significant risk reduction of 28% and 24% for the cilostazol group, respectively.…”

Periprocedural Neuroendovascular Antiplatelet Strategies for Thrombosis Prevention in Clopidogrel‐Hyporesponsive Patients

“…Similarly, a study in patients with ischemic stroke or carotid artery stenting reported a significantly lower PRU (113.3 vs 170.2, p=0.021) and higher percentage platelet inhibition (64.9% vs 41.7%, p=0.005) in patients receiving cilostazol in combination with clopidogrel compared with clopidogrel monotherapy, respectively . A meta‐analysis found that cilostazol, either as monotherapy or in combination antiplatelet therapy in patients undergoing carotid artery stenting, was associated with a lower in‐stent restenosis rate compared with regimens without cilostazol; however, no significant difference was found in composite rates of myocardial infarction, stroke, or death . In patients with acute myocardial infarction undergoing coronary stenting in Korea, compared with a high‐dose clopidogrel regimen (clopidogrel 150 mg/day plus aspirin 200 mg/day), triple antiplatelet therapy (clopidogrel 75 mg/day plus aspirin 200 mg/day plus cilostazol 100 mg twice/day) resulted in a nonsignificant decrease in P2Y12 PRU (184.5 vs 131.5, p=0.085) and a significant increase in percentage platelet inhibition (42.5% vs 55.0%, p=0.034), respectively .…”

“…45 A meta-analysis found that cilostazol, either as monotherapy or in combination antiplatelet therapy in patients undergoing carotid artery stenting, was associated with a lower in-stent restenosis rate compared with regimens without cilostazol; however, no significant difference was found in composite rates of myocardial infarction, stroke, or death. 46 In patients with acute myocardial infarction undergoing coronary stenting in Korea, compared with a high-dose clopidogrel regimen (clopidogrel 150 mg/day plus aspirin 200 mg/day), triple antiplatelet therapy (clopidogrel 75 mg/day plus aspirin 200 mg/day plus cilostazol 100 mg twice/day) resulted in a nonsignificant decrease in P2Y12 PRU (184.5 vs 131.5, p=0.085) and a significant increase in percentage platelet inhibition (42.5% vs 55.0%, p=0.034), respectively. 47 Baseline clopidogrel hyporesponsiveness was not reported in this study.…”

Restenosis after carotid artery stenting

“…A recent meta-analysis involving 1233 patients also indicated that cilostazol treatment was associated with a significantly lower ISR incidence after CAS during a mean follow-up of 20 months. 92 Authors concluded that cilostazol may decrease the ISR rates after CAS without affecting the risk of cardiovascular events and death, in both early and late settings.…”