Cilostazol Helps Prevent Carotid In-Stent Restenosis

I would think this whole problem could be eliminated by:

1. Determining if the Circle of Willis is complete.

2. If yes, then close the artery off to prevent ANY POSSIBILITY of clots breaking off and traveling to the brain.

3. This prevents stent placement complications per European Society of Cardiology

A - Minor complications

• Carotid artery spasm
• Sustained hypotension / bradycardia
• Carotid artery dissection
• Contrast encephalopathy (very rare)
• Minor embolic neurological events (TIAs)

B - Major complications

• Major embolic stroke
• Intracranial hemorrhage
• Hyperperfusion syndrome
• Carotid perforation (very rare)
• Acute stent thrombosis (very rare)
• Complications at the site of the vascular access

Don't listen to me, I'm not medically trained and I don't have a Dr. in front of my name.  But pepper your doctor with lots of questions, including GUARANTEEING NO PROBLEMS. Why would you want to place an inflexible stent in a flexible artery? Hell, my right carotid artery was 80% blocked at time of stroke which my doctors never found so luckily they didn't try to stent me. It eventually completely closed on its own with absolutely no cognitive problems encountered.

 

Cilostazol Helps Prevent Carotid In-Stent Restenosis

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]