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Hrbáč T, Fiedler J, Procházka V, Jonszta T, Roubec M, Pakizer D, Václavík D, Netuka D, Heryán T, Školoudík D. Comparison of carotid endarterectomy and repeated carotid angioplasty and stenting for in-stent restenosis (CERCAS trial): a randomised study. Stroke Vasc Neurol 2023; 8:399-404. [PMID: 36972920 PMCID: PMC10648045 DOI: 10.1136/svn-2022-002075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/13/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND AND AIM In-stent restenosis (ISR) belongs to an infrequent but potentially serious complication after carotid angioplasty and stenting in patients with severe carotid stenosis. Some of these patients might be contraindicated to repeat percutaneous transluminal angioplasty with or without stenting (rePTA/S). The purpose of the study is to compare the safety and effectiveness of carotid endarterectomy with stent removal (CEASR) and rePTA/S in patients with carotid ISR. METHODS Consecutive patients with carotid ISR (≥80%) were randomly allocated to the CEASR or rePTA/S group. The incidence of restenosis after intervention, stroke, transient ischaemic attack myocardial infarction and death 30 days and 1 year after intervention and restenosis 1 year after intervention between patients in CEASR and rePTA/S groups were statistically evaluated. RESULTS A total of 31 patients were included in the study; 14 patients (9 males; mean age 66.3±6.6 years) were allocated to CEASR and 17 patients (10 males; mean age 68.8±5.6 years) to the rePTA/S group. The implanted stent in carotid restenosis was successfully removed in all patients in the CEASR group. No clinical vascular event was recorded periproceduraly, 30 days and 1 year after intervention in both groups. Only one patient in the CEASR group had asymptomatic occlusion of the intervened carotid artery within 30 days and one patient died in the rePTA/S group within 1 year after intervention. Restenosis after intervention was significantly greater in the rePTA/S group (mean 20.9%) than in the CEASR group (mean 0%, p=0.04), but all stenoses were <50%. Incidence of 1-year restenosis that was ≥70% did not differ between the rePTA/S and CEASR groups (4 vs 1 patient; p=0.233). CONCLUSION CEASR seems to be effective and save procedures for patients with carotid ISR and might be considered as a treatment option. TRIAL REGISTRATION NUMBER NCT05390983.
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Affiliation(s)
- Tomáš Hrbáč
- Department of Neuroscience, Faculty of Medicine, Univerzity of Ostrava, Ostrava, Czech Republic
- Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Jiří Fiedler
- Department of Neurosurgery, České Budějovice Hospital, České Budějovice, Czech Republic
| | - Václav Procházka
- Department of Radiology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Tomáš Jonszta
- Department of Radiology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Martin Roubec
- Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic
| | - David Pakizer
- Center for Health Research, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Daniel Václavík
- Department of Neurology, Vítkovice Hospital, Ostrava, Czech Republic
| | - David Netuka
- Department of Neurosurgery, Military University Hospital Prague, Praha, Czech Republic
| | - Tomáš Heryán
- Center for Health Research, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - David Školoudík
- Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic
- Center for Health Research, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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Saleem T, Raju S. An overview of in-stent restenosis in iliofemoral venous stents. J Vasc Surg Venous Lymphat Disord 2021; 10:492-503.e2. [PMID: 34774813 DOI: 10.1016/j.jvsv.2021.10.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/13/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although endovenous stents have been associated with overall low morbidity, they can require reinterventions to correct stent malfunction due to in-stent restenosis (ISR). ISR has often occurred iliofemoral venous stents but has not been well described. It has been reported to develop in >70% of patients who have undergone iliofemoral venous stenting. We sought to provide an overview of ISR in iliofemoral venous stents, including the pathologic, diagnostic, and management considerations and the identification of several areas of potential research in the future. METHODS A search of reported English-language studies was performed in PubMed and the Cochrane Library. "In-stent restenosis," "vein," "venous," "iliac," and "iliofemoral" were used as keywords. The pertinent reports included in the present review had addressed the pathology, diagnosis, and current management options for ISR. RESULTS ISR refers to the narrowing of the luminal caliber of the stent owing to the development of stenosis inside the stent itself. ISR should be differentiated from stent compression. Two main types of ISR have been described: soft and hard lesions. These lesions respond differently to angioplasty. Stent inflow and shear stress are important factors in the development of ISR. The treatment options available at present include balloon angioplasty (hyperdilation or isodilation), laser ablation, atherectomy, and Z-stent placement. CONCLUSIONS Reintervention for ISR should be determined by the presence of residual or recurrent symptoms and not simply by a numeric value obtained from an imaging study. Overall stent occlusion due to ISR is rare, and no role exists for prophylactic angioplasty to treat asymptomatic ISR. The current treatment options for ISR are mostly durable and effective. However, more research is needed on methods to prevent the development of ISR. The role of antiplatelet and anticoagulant agents in the prevention of ISR requires further investigation, with particular attention to unique subset of patients (after thrombosis vs nonthrombotic iliac vein lesions). For high-risk, post-thrombotic patients, anticoagulation can be considered to prevent ISR. The role of triple therapy (anticoagulation and dual antiplatelet therapy) in the prevention of ISR remains unclear.
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Affiliation(s)
- Taimur Saleem
- The RANE Center for Venous and Lymphatic Diseases, Jackson, Miss.
| | - Seshadri Raju
- The RANE Center for Venous and Lymphatic Diseases, Jackson, Miss
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Manolis AA, Manolis TA, Melita H, Mikhailidis DP, Manolis AS. Update on Cilostazol: A Critical Review of Its Antithrombotic and Cardiovascular Actions and Its Clinical Applications. J Clin Pharmacol 2021; 62:320-358. [PMID: 34671983 DOI: 10.1002/jcph.1988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/17/2021] [Indexed: 12/17/2022]
Abstract
Cilostazol, a phosphodiesterase III inhibitor, has vasodilating and antiplatelet properties with a low rate of bleeding complications. It has been used over the past 25 years for improving intermittent claudication in patients with peripheral artery disease (PAD). Cilostazol also has demonstrated efficacy in patients undergoing percutaneous revascularization procedures for both PAD and coronary artery disease. In addition to its antithrombotic and vasodilating actions, cilostazol also inhibits vascular smooth muscle cell proliferation via phosphodiesterase III inhibition, thus mitigating restenosis. Accumulated evidence has shown that cilostazol, due to its "pleiotropic" effects, is a useful, albeit underutilized, agent for both coronary artery disease and PAD. It is also potentially useful after ischemic stroke and is an alternative in those who are allergic or intolerant to classical antithrombotic agents (eg, aspirin or clopidogrel). These issues are herein reviewed together with the pharmacology and pharmacodynamics of cilostazol. Large studies and meta-analyses are presented and evaluated. Current guidelines are also discussed, and the spectrum of cilostazol's actions and therapeutic applications are illustrated.
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Affiliation(s)
| | | | | | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK
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Dowlati E, Pasko KBD, Liu J, Miller CA, Felbaum DR, Sur S, Chang JJ, Liu AH, Armonda RA, Mai JC. Treatment of In-Stent Stenosis Following Flow Diversion of Intracranial Aneurysms with Cilostazol and Clopidogrel. Neurointervention 2021; 16:285-292. [PMID: 34503310 PMCID: PMC8561031 DOI: 10.5469/neuroint.2021.00290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/26/2021] [Indexed: 12/01/2022] Open
Abstract
In-stent stenosis is a feared complication of flow diversion treatment for cerebral aneurysms. We present 2 cases of patients treated with pipeline flow diversion for unruptured cerebral aneurysms. Initial perioperative dual antiplatelet therapy (DAPT) consisted of standard aspirin plus clopidogrel. At 6-month follow-up cerebral angiography, the patients were noted to have developed significant in-stent stenosis (63% and 53%). The patients were treated with cilostazol and clopidogrel for at least 6 months. Subsequent angiography at 1-year post-treatment showed significant improvement of the in-stent stenosis from 63% to 34% and 53% to 21%. The role of cilostazol as treatment of intracranial in-stent stenosis has not been previously described. Cilostazol’s vasodilatory effect and suppression of vascular smooth muscle proliferation provides ideal benefits in this setting. Cilostazol plus clopidogrel may be a safe and effective alternative to standard DAPT for treatment of in-stent stenosis following flow diversion and warrants further consideration and investigation.
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Affiliation(s)
- Ehsan Dowlati
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | | | - Jiaqi Liu
- Georgetown University School of Medicine, Washington, DC, USA
| | - Charles A Miller
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Daniel R Felbaum
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA.,Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Samir Sur
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA.,Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Jason J Chang
- Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ai-Hsi Liu
- Department of Radiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Rocco A Armonda
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA.,Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Jeffrey C Mai
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA.,Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC, USA
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Taguchi H, Takayama K, Kishida H, Wada T, Myouchin K, Tanaka T, Kichikawa K. A Case of Intraprocedural Plaque Protrusion during Carotid Artery Stenting Using the Stent-in-Stent Technique for Carotid Artery Stenosis with Unstable Plaque. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 16:46-51. [PMID: 37502026 PMCID: PMC10370619 DOI: 10.5797/jnet.cr.2020-0207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/14/2021] [Indexed: 07/29/2023]
Abstract
Objective Carotid artery stenting (CAS) using the stent-in-stent technique was reported to prevent intraprocedural plaque protrusion (PP) in patients with carotid artery stenosis with unstable plaque. We report a case of intraoperative PP after CAS despite the use of stent-in-stent technique. Case Presentation A 63-year-old man presented with rapid progression of right carotid artery stenosis with unstable plaque during follow-up and was admitted to undergo CAS. Under local anesthesia with Mo.Ma Ultra and FilterWire EZ protection, CAS was performed using the stent-in-stent technique. The first 8 mm × 29 mm Carotid Wallstent (CWS) was placed. The second CWS (6 mm × 22 mm) was placed in a stent-in-stent manner to match the stenotic lesion, and conservative postdilation was performed. Then the third CWS (6 mm × 22 mm) was added due to the presence of PP on intravascular ultrasonography (IVUS). No postoperative neurological abnormalities were found, and no new high-signal areas were observed on diffusion-weighted MRI the day after surgery. The patient was discharged without postoperative complications. No stroke and restenosis were observed at 3 months after CAS. Conclusion PP can occur even with stent-in-stent technique, suggesting the importance of diagnosis by IVUS.
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Affiliation(s)
- Hidehiko Taguchi
- Department of Interventional Neuroradiology and Radiology, Koseikai Takai Hospital, Tenri, Nara, Japan
- Department of Radiology, Higashiosaka City Medical Center, Higashiosaka, Osaka, Japan
- Department of Radiology, Nara Medical University, Kashihara, Nara, Japan
| | - Katsutoshi Takayama
- Department of Interventional Neuroradiology and Radiology, Koseikai Takai Hospital, Tenri, Nara, Japan
| | - Hayato Kishida
- Department of Interventional Neuroradiology and Radiology, Koseikai Takai Hospital, Tenri, Nara, Japan
| | - Takeshi Wada
- Department of Interventional Neuroradiology and Radiology, Koseikai Takai Hospital, Tenri, Nara, Japan
| | - Kaoru Myouchin
- Department of Radiology, Nara Medical University, Kashihara, Nara, Japan
| | - Toshihiro Tanaka
- Department of Radiology, Nara Medical University, Kashihara, Nara, Japan
| | - Kimihiko Kichikawa
- Department of Radiology, Nara Medical University, Kashihara, Nara, Japan
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Myouchin K, Takayama K, Wada T, Miyasaka T, Tanaka T, Kotsugi M, Kurokawa S, Nakagawa H, Kichikawa K. Carotid Artery Stenting Using a Closed-Cell Stent-in-Stent Technique for Unstable Plaque. J Endovasc Ther 2019; 26:565-571. [PMID: 31074315 DOI: 10.1177/1526602819847698] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To examine whether carotid artery stenting (CAS) of stenoses with unstable plaque using a closed-cell stent-in-stent technique prevents plaque protrusion. Materials and Methods: Between December 2014 and August 2018, 35 consecutive patients (mean age 75.8 years; 29 men) with carotid artery stenosis (20 symptomatic) and unstable plaque diagnosed by magnetic resonance imaging were prospectively analyzed. Mean diameter stenosis was 83.5%. All CAS procedures were performed with stent-in-stent placement of Carotid Wallstents using an embolic protection device and conservative postdilation. The technical success rate, incidence of plaque protrusion, ischemic stroke rate within 30 days, and new ipsilateral ischemic lesions on diffusion-weighted imaging (DWI) within 48 hours after CAS were prospectively assessed. Follow-up outcomes included the incidences of ipsilateral stroke and restenosis. Results: The technical success rate was 100%. No plaque protrusion or stroke occurred in any patient. New ischemic lesions were observed on DWI in 10 (29%) patients. During the mean 11.6-month follow-up, no ipsilateral strokes occurred. Two (6%) patients developed asymptomatic restenosis recorded as 53% lumen narrowing and occlusion, respectively. Conclusion: CAS using a closed-cell stent-in-stent technique for unstable plaque may be useful for preventing plaque protrusion and ischemic complications.
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Affiliation(s)
- Kaoru Myouchin
- 1 Department of Radiology and Interventional Neuroradiology, Ishinkai Yao General Hospital, Yao, Japan
| | - Katsutoshi Takayama
- 1 Department of Radiology and Interventional Neuroradiology, Ishinkai Yao General Hospital, Yao, Japan
| | - Takeshi Wada
- 2 Department of Radiology and Interventional Radiology Center, Nara Medical University, Kashihara, Japan
| | - Toshiteru Miyasaka
- 2 Department of Radiology and Interventional Radiology Center, Nara Medical University, Kashihara, Japan
| | - Toshihiro Tanaka
- 2 Department of Radiology and Interventional Radiology Center, Nara Medical University, Kashihara, Japan
| | - Masashi Kotsugi
- 3 Department of Neurosurgery, Ishinkai Yao General Hospital, Yao, Japan
| | | | - Hiroyuki Nakagawa
- 2 Department of Radiology and Interventional Radiology Center, Nara Medical University, Kashihara, Japan
| | - Kimihiko Kichikawa
- 2 Department of Radiology and Interventional Radiology Center, Nara Medical University, Kashihara, Japan
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Hassan AE, Zacharatos H, Grigoryan M, Tekle WG, Khan A, Siddiq F, Rodriguez GJ, Tummala R, Jagadeesan B, Suri MFK, Qureshi AI. Open-Label Phase I Clinical Study to Assess the Safety and Efficacy of Cilostazol in Patients Undergoing Internal Carotid Artery Stent Placement. INTERVENTIONAL NEUROLOGY 2017; 6:42-48. [PMID: 28611833 DOI: 10.1159/000452308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND One-month dual antiplatelet treatment, with aspirin and clopidogrel, following internal carotid artery stent placement is the current standard of care to prevent in-stent thrombosis. Cilostazol, an antiplatelet drug, has been demonstrated to have a safety profile comparable to aspirin and clopidogrel. OBJECTIVE To evaluate the safety and clinical efficacy of cilostazol and aspirin therapy following internal carotid artery stent placement up to 1 month postprocedure. METHODS A phase I open-label, nonrandomized two-center prospective study was conducted. All subjects received aspirin (325 mg/day) and cilostazol (200 mg/day) 3 days before extracranial stent placement. Two antiplatelet agents were continued for 1 month postprocedure followed by aspirin daily monotherapy. The primary efficacy end point was the 30-day composite occurrence of death, cerebral infarction, transient ischemic attack, and in-stent thrombosis. The primary safety end point was bleeding. RESULTS Twelve subjects (mean age ± SD, 66 ± 12 years; 9 males) were enrolled and underwent internal carotid artery angioplasty and stent placement. None of the subjects who successfully followed the study protocol experienced any complications at the 1- and 3-month follow-ups. One patient had a protocol deviation due to concurrent use of enoxaparin (1 mg/kg twice daily) in addition to aspirin and cilostazol, resulting in a fatal symptomatic intracerebral hemorrhage following successful stent placement on postprocedure day 1. One patient discontinued cilostazol after the first dose secondary to dizziness. CONCLUSION The use of cilostazol and aspirin for internal carotid artery stent placement appears to be safe, but protocol compliance needs to be emphasized.
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Affiliation(s)
- Ameer E Hassan
- Valley Baptist Brain and Spine Network, University of Texas Health Science Center - San Antonio, Harlingen, TX, MN, USA
| | | | | | - Wondwossen G Tekle
- Valley Baptist Brain and Spine Network, University of Texas Health Science Center - San Antonio, Harlingen, TX, MN, USA
| | | | | | | | | | | | | | - Adnan I Qureshi
- Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, MN, USA
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Dr. Enomoto responds:. J Vasc Interv Radiol 2016; 27:780. [DOI: 10.1016/j.jvir.2016.01.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 01/18/2016] [Indexed: 11/22/2022] Open
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Galyfos G, Geropapas G, Sigala F, Aggeli K, Sianou A, Filis K. Meta-Analysis of Studies Evaluating the Effect of Cilostazol on Major Outcomes After Carotid Stenting. J Endovasc Ther 2015; 23:186-95. [PMID: 26620397 DOI: 10.1177/1526602815619409] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the effect of cilostazol on major outcomes after carotid artery stenting (CAS). METHODS A systematic literature review was conducted conforming to established criteria in order to identify articles published prior to May 2015 evaluating major post-CAS outcomes in patients treated with cilostazol vs patients not treated with cilostazol. Major outcomes included in-stent restenosis (ISR) within the observation period, the revascularization rate, major/minor bleeding, and the myocardial infarction/stroke/death rate (MI/stroke/death) at 30 days and within the observation period. Data were pooled for all studies containing adequate data for each outcome investigated; effect estimates are presented as the odds ratios (ORs) and 95 confidence intervals (CI). RESULTS Overall, 7 studies pertaining to 1297 patients were eligible. Heterogeneity was low among studies so a fixed-effect analysis was conducted. Six studies (n=1233) 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 to 0.349, p<0.001). Five studies (n=649) were compared regarding 30-day MI/stroke/death (OR 0.724, 95% CI 0.293 to 1.789, p=0.484) and 3 studies (n=1076) were analyzed regarding MI/stroke/death within the entire follow-up period (OR 0.768, 95% CI 0.477 to 1.236, p=0.276); no significant difference was found between the groups. Data on bleeding rates and revascularization rates post ISR were inadequate to conduct further analysis. CONCLUSION Cilostazol seems to decrease total ISR rates in patients undergoing CAS without affecting MI/stroke/death events, both in the early and late settings.
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Affiliation(s)
- George Galyfos
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece Department of Vascular Surgery, KAT General Hospital, Athens, Greece
| | | | - Fragiska Sigala
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - Konstantina Aggeli
- First Department of Cardiology, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - Argiri Sianou
- Department of Microbiology, University of Athens Medical School, Areteion Hospital, Athens, Greece
| | - Konstantinos Filis
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
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Bhogal P, Brouwer PA, Makalanda HLD. Cilostazol: an antiplatelet agent for the neurointerventionist? J Neurointerv Surg 2014; 8:208-9. [PMID: 25526917 DOI: 10.1136/neurintsurg-2014-011570] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 11/27/2014] [Indexed: 11/04/2022]
Abstract
Antiplatelet agents are essential for the successful management of patients undergoing a variety of neurointerventional procedures. The most commonly used anti-platelet agents are aspirin, clopidogrel and prasugrel. However, there exist an alternative class of anti-platelet agent that may prove useful for neurointerventionists. In particular a drug called cilostazol may have numerous added advantages above and beyond its antiplatelet effect that may be valuable for our patients. In this short review we aim to highlight some of these potential advantages.
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Affiliation(s)
- P Bhogal
- Department of Neuroradiology, The Karolinska University Hospital, Stockholm, Sweden
| | - P A Brouwer
- Department of Neuroradiology, The Karolinska University Hospital, Stockholm, Sweden
| | - H L D Makalanda
- Department of Interventional Neuroradiology, The Royal London Hospital, London, UK
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Carotid artery stents on CT angiography: In vitro comparison of different stent designs and sizes using 16-, 64- and 320-row CT scanners. J Neuroradiol 2014; 41:259-68. [DOI: 10.1016/j.neurad.2013.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 10/08/2013] [Accepted: 10/22/2013] [Indexed: 11/18/2022]
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Efficacy of Cilostazol in Prevention of Bradycardia during Carotid Artery Stenting. J Stroke Cerebrovasc Dis 2014; 23:662-6. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 05/28/2013] [Accepted: 06/07/2013] [Indexed: 11/19/2022] Open
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Nakagawa I, Wada T, Park HS, Nishimura F, Yamada S, Nakagawa H, Kichikawa K, Nakase H. Platelet inhibition by adjunctive cilostazol suppresses the frequency of cerebral ischemic lesions after carotid artery stenting in patients with carotid artery stenosis. J Vasc Surg 2014; 59:761-7. [DOI: 10.1016/j.jvs.2013.09.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/05/2013] [Accepted: 09/06/2013] [Indexed: 11/25/2022]
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Enomoto Y, Yoshimura S. Antiplatelet therapy for carotid artery stenting. INTERVENTIONAL NEUROLOGY 2013; 1:151-63. [PMID: 25187775 PMCID: PMC4031772 DOI: 10.1159/000351686] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Carotid artery stenting (CAS) is less invasive and has a lower incidence of systemic complications such as myocardial infarction compared with carotid endarterectomy. However, CAS is known to have a high incidence of ischemic complications due to distal thromboembolism. Progress has been made in the development of various distal protection devices and protection methods aimed at preventing thromboembolism. Similar to these methods, perioperative antiplatelet therapy is also able to play a very important role in the prevention of ischemic events. Dual antiplatelet therapy has become standard for perioperative management of CAS.
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Affiliation(s)
- Yukiko Enomoto
- Department of Neurosurgery, Graduate School of Medicine, Gifu University, Gifu City, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Graduate School of Medicine, Gifu University, Gifu City, Japan
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