Meta-Analysis Suggests Cilostazol Decreases ISR After Carotid Stenting

December 21, 2015—George Galyfos, MD, et al conducted a meta-analysis of studies evaluating the effect of cilostazol on major outcomes after carotid artery stenting (CAS). They concluded that cilostazol appears to decrease total in-stent restenosis (ISR) rates in patients undergoing CAS without affecting myocardial infarction (MI), stroke, or death events, both in the early and late settings. The findings are available online ahead of print in the Journal of Endovascular Therapy  (JEVT).

For the meta-analysis, the investigators conducted a systematic literature review of articles published before May 2015 evaluating major post-CAS outcomes in patients treated with cilostazol versus patients not treated with cilostazol. Major outcomes included ISR within the observation period, the revascularization rate, major/minor bleeding, and the MI/stroke/death rate at 30 days and within the observation period. Data were pooled for all studies containing adequate data for each outcome investigated. The effect estimates are presented as odds ratios (ORs) and 95% confidence intervals (CIs). 

As summarized in JEVT, the investigators identified seven studies that included 1,297 eligible patients. Heterogeneity was low among studies, so a fixed-effect analysis was performed. Six studies (n = 1,233) were compared for the ISR endpoint, showing a significantly lower ISR rate with cilostazol treatment after a mean follow-up of 20 months (OR, 0.158; 95% CI, 0.072–0.349; P < .001). Five studies (n = 649) were compared for the 30-day MI/stroke/death rates (OR, 0.724; 95% CI, 0.293–1.789; P = .484), and three studies (n = 1,076) were analyzed regarding MI/stroke/death rates within the entire follow-up period (OR, 0.768; 95% CI, 0.477–1.236; P = .276); no significant difference was found between the groups. 

Data on bleeding rates and revascularization rates post-ISR were inadequate to conduct further analysis, noted the investigators in JEVT.