Original title: Impact of Cilostazol on Angiographic Restenosis after Balloon Angioplasty for Infrapopliteal Artery Disease in Patients with Critical Limb Ischemia Reference: Y. Soga et al. European Journal of Vascular and Endovascular Surgery 44 (2012) 577e581.

Angioplasty is regularly used for patients with critical limb ischemia where restenosis is a great limitation, especially in infrapopliteal territory. 

The use of stents and paclitaxel eluting balloons seems promising; however using it in all infrapopliteal lesions is not affordable. The aim of this study that included 63 patients (32 in the cilostazol group and 31 in the control group) was to assess whether cilostazol reduces binary restenosis at three months follow up. All patients presented critical limb ischemia.

Cilostazol group showed lower binary restenosis (56% vs. 86%, p=0,015), lower reocclusion (20,5% vs. 42,1%, p=0,02) and lower target lesion revascularization (27,5% vs 49,1%) compared to the control group. Looking at clinical outcomes of affected limbs, instead of the angiographical lesions, no differences were found between the two groups, as regards both ulcer healing and member salvage.

Conclusion 

Cilostazol could reduce restenosis and revascularization after infrapopliteal angioplasty in patients with critical limb ischemia.

Editorial Comment:

This work has several important limitations such as the fact that it was a retrospective analysis and that cilostazol was indicated following operator’s criterion. The small number of patients enrolled in this study is also a limitation, as well as follow at three months. On the other hand, this study shows real life results (they did not use drug eluting stents or balloons) of infrapopliteal limb salvage angioplasty where all additional measures can have relative impact in the context of such poor results. No one can doubt that, though promising, cilostazol needs further randomized studies assessment.

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