Original ArticlePeriprocedural Cilostazol Treatment and Restenosis after Carotid Artery Stenting: The Retrospective Study of In-Stent Restenosis after Carotid Artery Stenting (ReSISteR-CAS)
Section snippets
Materials and Methods
The Retrospective Study of In-Stent-Restenosis after Carotid Artery Stenting (ReSISteR-CAS) study group comprised 11 Japanese stroke centers. In this study, consecutive patients who underwent CAS for atherosclerotic severe carotid stenosis in these 11 centers between April 2003 (when cilostazol was approved for ischemic stroke in Japan) and August 2006 were registered. The study included patients who could be observed over 30 months after CAS and underwent digital subtraction angiography (DSA),
Results
Of the 580 patients enrolled, 553 were analyzed. Of these, 207 patients (37.4%) were treated periprocedurally with cilostazol. The cilostazol dosage was 100 mg/day in 23 patients (11.1%), 150 mg/day in 3 patients (1.4%), and 200 mg/day in 181 patients (87.4%). Antiplatelet drugs other than cilostazol included aspirin (81–200 mg/day) in 485 patients (87.7%), ticlopidine (100–300 mg/day) in 322 patients (58.2%), and others (including clopidogrel) in 30 patients (5.4%).
Table 1 summarizes patient
Discussion
In this study, the composite incidence of ISR or TVR after CAS was lower in the treated group compared with the untreated group. In addition, cilostazol use and stent diameter were independently associated with the development of ISR after adjustment for other putative factors.
ISR within 30 months after CAS occurred in 4.2% of patients, and TVR was performed in 2.9%. Groschel et al8 reviewed reports on ISR after CAS between 1990 and 2004 and found an incidence of ≥50% postprocedural ISR of
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2019, World NeurosurgeryCitation Excerpt :All the studies had reported the adjusted HRs from multivariate analyses, except for 3 studies, which had provided unadjusted HRs only.18,32,33 Restenosis after carotid revascularization was defined as stenosis ≥50% in 11 studies,22,24,26,27,29,30,32-35,37 ≥70% in 6 studies,18,19,21,23,28,36 and >80% in 1 study.20 Diabetes mellitus showed a statistically significant association with restenosis after carotid revascularization (HR, 1.68; 95% CI, 1.00–2.83; I2, 76.7%) but was without statistical significance in the subgroup analyses for CEA and CAS (CEA: HR, 1.75; 95% CI, 0.81–3.76; and CAS: HR, 1.64; 95% CI, 0.70–3.80; Figure 2).
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