Galyfos George, Geropapas Georgios, Sigala Fragiska, Aggeli Konstantina, Sianou Argiri, Filis Konstantinos
First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece Department of Vascular Surgery, KAT General Hospital, Athens, Greece
Department of Vascular Surgery, KAT General Hospital, Athens, Greece.
J Endovasc Ther. 2016 Feb;23(1):186-95. doi: 10.1177/1526602815619409. Epub 2015 Nov 30.
To evaluate the effect of cilostazol on major outcomes after carotid artery stenting (CAS).
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).
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.
Cilostazol seems to decrease total ISR rates in patients undergoing CAS without affecting MI/stroke/death events, both in the early and late settings.
评估西洛他唑对颈动脉支架置入术（CAS）后主要结局的影响。
按照既定标准进行系统的文献综述，以识别2015年5月之前发表的评估接受西洛他唑治疗的患者与未接受西洛他唑治疗的患者CAS后主要结局的文章。主要结局包括观察期内的支架内再狭窄（ISR）、血管再通率、严重/轻微出血以及30天和观察期内的心肌梗死/中风/死亡率（MI/中风/死亡）。对所有包含每个研究结局足够数据的研究进行数据汇总；效应估计值以比值比（OR）和95%置信区间（CI）表示。
总体而言，7项涉及1297例患者的研究符合条件。研究之间的异质性较低，因此进行了固定效应分析。对6项研究（n = 1233）的ISR终点进行了比较，在平均随访20个月后，西洛他唑治疗组的ISR率显著更低（OR 0.158，95% CI 0.072至0.349，p < 0.001）。对5项研究（n = 649）的30天MI/中风/死亡情况进行了比较（OR 0.724，95% CI 0.293至1.789，p = 0.484），对3项研究（n = 1076）的整个随访期内的MI/中风/死亡情况进行了分析（OR 0.768，95% CI 0.477至1.236，p = 0.276）；两组之间未发现显著差异。ISR后出血率和血管再通率的数据不足以进行进一步分析。
西洛他唑似乎能降低接受CAS患者的总ISR率，且在早期和晚期均不影响MI/中风/死亡事件。
