Cilostazol reduces restenosis after carotid artery stenting

J Vasc Surg. 2010 Jan;51(1):51-6. doi: 10.1016/j.jvs.2009.08.040. Epub 2009 Oct 30.


Background: Although carotid artery stenting (CAS) has been proposed as an alternative to carotid endarterectomy in cerebral revascularization, restenosis remains an unsolved issue. Cilostazol is a unique antiplatelet drug that has vasodilatory effects and inhibits smooth muscle cell proliferation. We investigated whether cilostazol reduces restenosis after CAS.

Methods: A database of 113 consecutive CAS procedures between April 2002 and December 2007 was assessed retrospectively. All patients received aspirin (100 mg/d) and another antiplatelet drug such as cilostazol (200 mg/d), ticlopidine (200 mg/d), or clopidogrel (75 mg/d) at least 3 days before CAS. Two antiplatelet drugs were continued for 2 to 3 months after CAS and reduced to one thereafter. Patients were evaluated at 3 and 6 months and at 6-month intervals thereafter with duplex ultrasound (DUS) imaging. Angiography was used for confirmation when stenosis was suspected as >50% with DUS imaging.

Results: We were able to monitor 97 patients for a 12-month period. The overall combined rate of stroke, myocardial infarction, and death was 3.1% at 30 days and 4.1% at 1 year. In-stent recurrent stenosis was documented in 11 patients (11%); in 10 patients (9.7%), this occurred <or=12 months of CAS. In-stent restenosis was significantly reduced in the cilostazol (+) group (0% vs 15.7% [11 of 70], P = .03). Patient characteristics were similar between the cilostazol (+) and cilostazol (-) groups.

Conclusions: Although this study was retrospective and nonrandomized, the results suggest that cilostazol administration improves long-term patency after CAS due to its inhibitory effect on smooth muscle cell growth.

MeSH terms

  • Aged
  • Angioplasty / adverse effects
  • Angioplasty / instrumentation*
  • Angioplasty / mortality
  • Carotid Artery Diseases / diagnosis
  • Carotid Artery Diseases / drug therapy
  • Carotid Artery Diseases / mortality
  • Carotid Artery Diseases / therapy*
  • Cilostazol
  • Drug Therapy, Combination
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / etiology
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Retrospective Studies
  • Secondary Prevention
  • Stents*
  • Stroke / etiology
  • Tetrazoles / therapeutic use*
  • Time Factors
  • Treatment Outcome
  • Ultrasonography, Doppler, Duplex


  • Platelet Aggregation Inhibitors
  • Tetrazoles
  • Cilostazol