To evaluate the potential use of cilostazol in intracoronary stenting.
DATA SOURCES:
Clinical literature was accessed through MEDLINE (1966–March 2001). Key search terms included cilostazol, intracoronary stenting, and coronary angioplasty. Abstracts of clinical trials presented at major cardiology professional association meetings were also reviewed.
DATA SYNTHESIS:
Intracoronary stent placement represents the fastest growing medical device implant. Complications of stent implantation include acute and subacute vessel closure, as well as late restenosis. Currently, antiplatelet agents are used for preventive therapy. Cilostazol is a vasodilating antiplatelet agent that reversibly inhibits platelet aggregation induced by many factors. In seven randomized trials comparing cilostazol with either aspirin or ticlopidine, cilostazol was found to be superior to aspirin and equivalent to ticlopidine in decreasing both cardiac events and rates of restenosis. In addition, cilostazol was found to be well tolerated, with no reports of adverse hematologic events.
CONCLUSIONS:
Although further comparative trials are required, cilostazol appears to be a safe and effective alternative to clopidogrel and glycoprotein IIb/IIIa receptor antagonists following intracoronary stent implantation.
LaneDM. Dramatic increase in use of coronary stents (letter). Am J Cardiol1999; 84: 1141.
2.
MauroLSBorovickaMCKlineSS. Introduction to coronary artery stents and their pharmacotherapeutic management. Ann Pharmacother1997; 31: 1490–8.
3.
MishkelGJAguirreFVLigonRWRocha-SinghKJLucoreCL. Clopidogrel as adjunctive antiplatelet therapy during coronary stenting. J Am Coll Cardiol1999; 34: 1884–90.
4.
FischmanDLLeonMBBaimDSSchatzRASavageMPPennI. A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. Stent Restenosis Study Investigators. N Engl J Med1994; 331: 496–501.
5.
SerruysPWde JaegerePKiemeneijFMacayaCRutschWHeyndrickxG. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent Study Group. N Engl J Med1994; 331: 489–95.
6.
OchiaiMEtoKTakeshitaSYokoyamaNOshimaAKondoK. Impact of cilostazol on clinical and angiographic outcome after primary stenting for acute myocardial infarction. Am J Cardiol1999; 84: 1074–6.
LeonMBBaimDSPopmaJJGordonPCCutlipDEHoK. A clinical trial comparing three antithrombotic drug regimens after coronary-artery stenting. N Engl J Med1998; 339: 1665–71.
9.
DawsonDLCutlerBSMeissnerMHStrandnessDEJr.. Cilostazol has beneficial effects in treatment of intermittent claudication. Circulation1998; 98: 678–85.
OkudaYKimuraYYamashitaK. Cilostazol. Cardiovasc Drug Rev1993; 11: 451–65.
12.
Package insert. Pletal (cilostazol). Rockville, MD: Otsuka Pharmaceutical, January 1999.
13.
PackerMCarverJRRodehefferRJIvanhoeRJDiBiancoRZeldisSM. Effect of oral milrinone on mortality in severe congestive heart failure. N Engl J Med1991; 325: 1468–75.
14.
YamasakiMHaraKIkariYKobayashiNKozumaKOhmotoY. Effects of cilostazol on late lumen loss after Palmaz-Schatz stent implantation. Catheter Cardiovasc Diagnosis1998; 44: 387–91.
15.
KunishimaTMushaHEtoFIwasakiTNagashimaJMasuiY. A randomized trial of aspirin versus cilostazol therapy after successful coronary stent implantation. Clin Ther1997; 19: 1058–65.
16.
YoonYShimWHLeeDHPyunWBKimIJJangY. Usefulness of cilostazol versus ticlopidine in coronary artery stenting. Am J Cardiol1999; 84: 1375–80.
17.
ParkSWLeeCWKimHSLeeHJParkHKHongMK. Comparison of cilostazol versus ticlopidine therapy after stent implantation. Am J Cardiol1999; 84: 511–4.
18.
ParkSLeeCWKimHLeeNNahDYHongM. Effects of cilostazol on angiographic restenosis after coronary stent placement. Am J Cardiol2000; 86: 499–503.
19.
SekiyaMFunadaJWatanabeKMiyagawaMAkutsuH. Effects of probucol and cilostazol alone and in combination on frequency of post-stenting restenosis. Am J Cardiol1998; 82: 144–7.
20.
YoshitomiYKojimaSSugiTYanoMMatsumotoYKuramochiM. Antiplatelet treatment with cilostazol after stent implantation. Heart1998; 80: 393–6.
21.
KozumaKHaraKYamasakiMMorinoYAyabeSKurodaY. Effects of cilostazol on late lumen loss and repeat revascularization after Palmaz-Schatz coronary stent implantation. Am Heart J2001; 141: 124–30.
22.
MarsoSPLincoffAMEllisSGBhattDLTanguayJ-FKleimanNS. Optimizing the percutaneous interventional outcomes for patients with diabetes mellitus: Results of the EPISTENT (Evaluation of Platelet IIb/IIIa Inhibitor for Stenting Trial) diabetic substudy. Circulation1999; 100: 2477–84.
23.
BertrandMERupprechtHJUrbanPGershlickAH. Double-blind study of the safety of clopidogrel with and without a loading dose in combination with aspirin compared with ticlopidine in combination with aspirin after coronary stenting: The Clopidogrel Aspirin Stent International Cooperative Study (CLASSICS). Circulation2000; 102: 624–9.
24.
LincoffAMCaliffRMMoliternoDJEllisSGDucasJKramerJH. Complementary clinical benefits of coronary-artery stenting and blockade of platelet glycoprotein IIb/IIIa receptors. N Engl J Med1999; 341: 319–27.
25.
TopolEJMarkDBLincoffAMCohenEBurtonJKleimanN. Outcomes at 1 year and economic implications of platelet glycoprotein IIb/IIIa blockade in patients undergoing coronary stenting: Results from a multicentre randomised trial. EPISTENT Investigators. Evaluation of Platelet IIb/IIIa Inhibitor for Stenting. Lancet1999; 354: 2019–24.
26.
The EPISTENT Investigators. Randomised placebo-controlled and balloon-angioplasty-controlled trial to assess safety of coronary stenting with use of platelet glycoprotein-IIb/IIIa blockade. Evaluation of Platelet IIb/IIIa Inhibitor for Stenting. Lancet1998; 352: 87–92.
27.
The ESPRIT Investigators. Novel dosing regimen of eptifibatide in planned coronary stent implantation (ESPRIT): A randomised, placebo-controlled trial. Lancet2000; 356: 2037–44.
