Cilostazol Helps Prevent Carotid In-Stent Restenosis

February 25, 2020
By Alex Morrisson LOS ANGELES -- February 25, 2020 -- Patients undergoing carotid artery stenting to prevent recurrence of stroke who receive cilostazol tend to have a lower incidence of in-stent restenosis after 2 years, according to a study presented here at the 2020 International Stroke Conference (ISC). In the Carotid Artery Stenting with Cilostazol Addition for Restenosis (CAS-CARE) study, Hiroshi Yamagami, MD, Osaka National Hospital, Osaka, Japan, and colleagues analysed 631 patients aged 45 to 80 years with symptomatic (≥50%) or asymptomatic (≥80%) carotid artery stenosis who were scheduled for carotid artery stenting within 30 days of enrolment. The patients were randomised 1:1 to receive cilostazol (50 mg or 100 mg twice daily) or any antiplatelet agents other than cilostazol, from 3 days before carotid artery stenosis and continued for 2 years. The study found that in-stent restenosis occurred in 10.8% of patients receiving cilostazol and in 19.6% of patients who did not receive cilostazol -- a 36% reduction in the risk of in-stent restenosis that approached statistical significance (P = .056). In secondary endpoints, occurrences of cardiovascular events or death from any cause and bleeding events were similar between the groups (5.8% vs 6.2% and 1.1% vs 0.3%, respectively). Dr. Yamagami suggested that the study may have failed to reach significance because the trial recruited just 79% of its planned enrolment. “This is the first trial to show potential effectiveness of medical management for the prevention of in-stent restenosis after carotid artery stenting,” he concluded. ISC is sponsored by the American Heart Association and the American Stroke Association. [Presentation title: Cilostazol Versus Other Antiplatelet Drugs for the In-Stent Restenosis After Carotid Artery Stenting: The Carotid Artery Stenting With Cilostazol Addition for Restenosis (CAS-CARE) Trial. Abstract LB21]