Key result
Cilostazol-based dual antiplatelet treatment reduced new ipsilateral ischemic lesions compared to standard aspirin and clopidogrel (8% and 9% vs 25%; P=0.047) without hemorrhagic complications.
Why the study?
Does cilostazol-based dual antiplatelet treatment reduce new ischemic lesions and hemorrhagic complications in patients undergoing carotid artery stenting?
Cohort (n=137)
Does cilostazol-based dual antiplatelet treatment reduce new ischemic lesions and hemorrhagic complications in patients undergoing carotid artery stenting?
Absolute Event Rate: 8% vs 25%
p-value: p=0.047
Cilostazol-based dual antiplatelet therapy reduces clopidogrel resistance and suppresses new ischemic lesions without increasing hemorrhagic complications in patients undergoing carotid artery stenting.
BACKGROUND: It is essential that patients undergoing carotid artery stenting (CAS) receive optimal antiplatelet inhibition. Although a reduction in platelet reactivity and improved clinical outcomes occur when using adjunctive cilostazol with dual antiplatelet therapy, this can lead to an increased risk of hemorrhagic complications. Therefore, our current study examined patients undergoing CAS and evaluated the impact of cilostazol-based dual antiplatelet treatment on the outcomes. METHODS: Between 2010 and 2015, 137 consecutive patients underwent CAS. From 2010 to 2011 (period 1), 28 patients underwent CAS in conjunction with aspirin and clopidogrel dual antiplatelet treatment (DAPT). From 2010 to 2013 (period 2), 44 patients underwent a preoperative assessment of their platelet function, with the clopidogrel-resistant patients receiving adjunctive cilostazol in addition to the aspirin and clopidogrel. From 2013 to 2015 (period 3), 65 patients underwent CAS in conjunction with cilostazol and clopidogrel treatment. In all patients, the incidence of new ipsilateral ischemic lesions observed by diffusion-weighted imaging on the day after CAS, and ischemic or hemorrhagic events occurring within 30 days were assessed. RESULTS: Clopidogrel resistance was identified in 43% of the patients in period 1, in 16% in period 2, and in 5% in period 3 (P < 0.001). The on-treatment platelet reactivity results indicated that the PRU value during cilostazol-based DAPT was significantly lower than that observed for the standard DAPT (P < 0.05). New ipsilateral ischemic lesions decreased by 9% and 8% in periods 2 and 3, respectively, versus a 25% decrease in period 1 (P = 0.047). However, there were no significant differences noted for any of the hemorrhagic or thromboembolic events. CONCLUSIONS: Compared to the standard aspirin and clopidogrel dual antiplatelet therapy, cilostazol-based dual antiplatelet treatment reduces the rate of clopidogrel resistance and suppresses new ischemic lesions without hemorrhagic complications.
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Nakagawa et al. (2017) conducted a cohort in Carotid artery stenting (n=137). Cilostazol-based dual antiplatelet treatment vs. Aspirin and clopidogrel dual antiplatelet treatment was evaluated on New ipsilateral ischemic lesions observed by diffusion-weighted imaging on the day after CAS (p=0.047). Cilostazol-based dual antiplatelet treatment reduced new ipsilateral ischemic lesions compared to standard aspirin and clopidogrel (8% and 9% vs 25%; P=0.047) without hemorrhagic complications.
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