Continuous daily use of cilostazol prevents in-stent restenosis following carotid artery stenting: serial angiographic investigation of 229 lesions

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 3months and 1year 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 12months or more after CAS (12M CLS group, n=70), (2) patients who were treated with CLS for the first 3months 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 365days, 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 1year, 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 1year after CAS. Continuous daily use of CLS (for at least 1year) may have a beneficial effect on long term prevention of ISR.