Department of Neurosurgery, National Hospital Organization, Toyohashi Medical Center, Toyohashi City, Aichi, Japan.
AJNR Am J Neuroradiol. 2012 Aug;33(7):1262-6. doi: 10.3174/ajnr.A2955. Epub 2012 Feb 9.
The progression of atherosclerosis is related to various factors. Although antiplatelet therapy is used for the management of acute ischemic stroke and for the prevention of recurrent stroke, the antiplatelet agent cilostazol may also reduce restenosis after stent implantation in any vessel. This study was performed to assess the impact of cilostazol on plaque progression in the carotid artery contralateral to a stented artery.
Ninety-five patients who underwent contralateral CAS who also had ipsilateral 0%-79% ICS were enrolled. ICS was assessed by duplex sonography every 6 months and by MR imaging/angiography, and digital subtraction angiography if necessary, every 12 months according to the NASCET method. Patient age, sex, past history, and perioperative medical conditions were recorded.
While 22.1% of patients experienced disease progression, symptomatic ipsilateral stroke occurred in only 1.1% of patients over 36.2 ± 18.8 months. On multivariate analysis, precarotid stenosis (HR per 10% increase, 2.08; 95% CI, 1.43-3.05; P < .001) and cilostazol use (HR 0.16; 95% CI, 0.03-0.85; P = .03) were independent predictors for the progression of ICS.
A higher degree of initial stenosis is associated with progression of asymptomatic ICS. Cilostazol may reduce the rate of disease progression in patients with asymptomatic ICS.
动脉粥样硬化的进展与多种因素有关。尽管抗血小板治疗用于急性缺血性脑卒中的管理和预防复发性脑卒中，但抗血小板药物西洛他唑也可能减少任何血管支架植入后的再狭窄。本研究旨在评估西洛他唑对支架置入侧颈动脉对侧斑块进展的影响。
共纳入 95 例接受对侧 CAS 且同侧 ICS 为 0%-79%的患者。根据 NASCET 方法，每隔 6 个月通过双功能超声检查，每隔 12 个月通过 MRI/血管造影和数字减影血管造影评估 ICS。记录患者年龄、性别、既往病史和围手术期情况。
22.1%的患者出现疾病进展，36.2±18.8 个月后仅有 1.1%的患者出现症状性同侧卒中。多变量分析显示，颈动脉狭窄（每增加 10%的 HR，2.08；95%CI，1.43-3.05；P<.001）和西洛他唑使用（HR 0.16；95%CI，0.03-0.85；P=0.03）是 ICS 进展的独立预测因素。
初始狭窄程度较高与无症状 ICS 的进展有关。西洛他唑可能降低无症状 ICS 患者的疾病进展率。
