Cilostazol prevents progression of asymptomatic carotid artery stenosis in patients with contralateral carotid artery stenting

Abstract

Background and purpose: The progression of atherosclerosis is related to various factors. Although antiplatelet therapy is used for the management of acute ischemic stroke and for the prevention of recurrent stroke, the antiplatelet agent cilostazol may also reduce restenosis after stent implantation in any vessel. This study was performed to assess the impact of cilostazol on plaque progression in the carotid artery contralateral to a stented artery.

Materials and methods: Ninety-five patients who underwent contralateral CAS who also had ipsilateral 0%-79% ICS were enrolled. ICS was assessed by duplex sonography every 6 months and by MR imaging/angiography, and digital subtraction angiography if necessary, every 12 months according to the NASCET method. Patient age, sex, past history, and perioperative medical conditions were recorded.

Results: While 22.1% of patients experienced disease progression, symptomatic ipsilateral stroke occurred in only 1.1% of patients over 36.2 ± 18.8 months. On multivariate analysis, precarotid stenosis (HR per 10% increase, 2.08; 95% CI, 1.43-3.05; P < .001) and cilostazol use (HR 0.16; 95% CI, 0.03-0.85; P = .03) were independent predictors for the progression of ICS.

Conclusions: A higher degree of initial stenosis is associated with progression of asymptomatic ICS. Cilostazol may reduce the rate of disease progression in patients with asymptomatic ICS.

Fig 1.

Kaplan-Meier curves showing cumulative freedom from progression of ICS. Freedom from progression of ICS was significantly higher in the cilostazol (+) group compared with cilostazol (−) group (P = .006).