Cilostazol reduces restenosis of DES in lesions larger than 40 mm.

Original title: Comparison of Dual Versus Triple Antiplatelet Therapy After Drug-Eluting Stent According to Stent Length (from the Pooled Analysis of DECLARE Trials). Reference: Seung-Whan Lee et al. Am J Cardiol 2013, article in press.

Cilostazol, an inhibitor of phosphodiesterase III , associated with aspirin and clopidogrel showed decrease angiographic restenosis both in conventional stents as well as in DES. DECLARE-DIABETES and DECLARE-LONG I and II studies yielded these results, however the question remained regarding which patients would benefit most and the absence of clear criteria that triple therapy did not come into daily practice.

This paper analyzed the angiographic follow up of the 1399 patients randomized to dual therapy (aspirin + clopidogrel) or triple therapy (aspirin + clopidogrel + cilostazol) in the 3 studies mentioned above. The primary objective of the study was to find stent restenosis indicators that justify cilostazol indication after angioplasty using DES. In the group with a triple scheme, in-stent restenosis was significantly reduced (8.2 % vs 13.6 % , RR 0.6 , CI 0.53 to 0.84, P = 0.003 ) and in- segment restenosis (9.0 % vs 15.7 %, RR 0.58 , CI 0.53 to 0.65 , p = 0.001). The cutoff in stent length from which benefit was significant with cilostazol was 39.5 mm. By dividing patients according to the length of stents implanted ( ≤ 20, 20 to 40 and ≥ 40 mm) we observed a significant difference in favor of the group receiving Cilostazol, -those who received ≥ 40 mm           (12.4 % vs 22.1 % , p = 0.008 ) . A similar trend was observed after dividing patients according to minimal luminal diameter ( ≤ 2.5, 2.5 to 3, and > 3 mm) with the greatest benefit in the smallest diameter ( p = 0.022 to ≤ 2.5 mm ) . 

Conclusion:

The triple scheme group (aspirin, clopidogrel, cilostazol) showed a significant reduction of restenosis in patients with more than 40 mm of stent length. Therefore, the use of the triple therapy may be readily employed in clinical practice after angioplasty using DES.

Editorial Comment

From a practical standpoint, the total length covered by stents is a simple guide for the indication of cilostazol after implantation of DES. Angiographic follow-up in these studies was set at 6 months (DECLARE-DIABETES y LONG I) and 8 months (DECLARE-LONG II), which is relatively premature and may be sub-estimated the restenosis. Drug-eluting stents used were mostly from 1st  generation so we must be cautious in extrapolating the results to the newer generations.

SOLACI.ORG

More articles by this author

Coronary Artery Disease in Aortic Stenosis: CABG + SAVR vs. TAVR + PCI: Data from Spanish Centers

Multiple randomized studies have shown comparable or superior efficacy of transcatheter aortic valve replacement (TAVR) vs. coronary artery bypass graft (CABG).  However, many of...

Evolution of Small Balloon-Expandable Valves

Small aortic rings (20 mm) have posed a significant challenge for both surgery and transcatheter aortic valve implantation (TAVI) due to their association with an...

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 – ECLIPSE: Randomized Study of Orbital Atherectomy vs Conventional PCI in Severely Calcified Lesions

Coronary calcification is associated with stent under-expansion and increased risk of both early and late adverse events. Atherectomy is an essential tool for uncrossable...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Severe Tricuspid Regurgitation: Surgical vs. Transcatheter Edge-to-Edge Repair

While highly prevalent, tricuspid regurgitation is a notably undertreated valvulopathy. Its progression has been associated with higher mortality and significant disability. According to the...

ACCESS-TAVI: Comparing Post TAVR Vascular Closure Devices

Transcatheter aortic valve replacement (TAVR) is a well-established option to treat elderly patients with severe symptomatic aortic valve stenosis. Technical advances and device development...

Endovascular Treatment of Iliofemoral Disease for the Improvement of Heart Failure with Preserved Ejection Fraction

Peripheral artery disease (PAD) is a significant risk factor in the development of difficult-to-treat conditions, such as heart failure with preserved ejection fraction (HFpEF)....