1 Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
2 Department of Cardiology, Kansai Rosai Hospital, Amagasaki, Japan.
J Endovasc Ther. 2017 Oct;24(5):640-646. doi: 10.1177/1526602817719284. Epub 2017 Jul 5.
To investigate whether administering cilostazol after treatment for femoropopliteal in-stent restenosis (ISR) can have a positive impact on recurrent ISR (Re-ISR).
The database of a multicenter, retrospective, observational registry was interrogated to identify 338 consecutive patients (mean age 72.3±8.8 years; 148 men) who underwent endovascular therapy for femoropopliteal ISR in 379 limbs from January 2010 to December 2014. Ninety-seven patients (103 limbs) who received cilostazol after the initial stent implantation procedure were excluded. This left 24 ISR patients (30 limbs) who received cilostazol initially after ISR treatment for comparison with 217 ISR patients (246 limbs) who did not receive the drug. The primary endpoint was 2-year Re-ISR after treatment. The secondary endpoints were recurrent target lesion revascularization (Re-TLR) and reocclusion at 2 years. Restenosis was determined by a peak systolic velocity ratio >2.4 on a duplex scan or >50% stenosis on angiography.
The mean follow-up was 23.3±15.5 months. At 2 years, freedom from Re-ISR was significantly higher in the cilostazol group than in the no cilostazol group (48.6% vs 32.4%, p=0.047). However, freedom from Re-TLR and reocclusion between the 2 groups did not differ significantly [64.7% vs 53.8% (p=0.15) and 88.3% vs 73.9% (p=0.11), respectively]. After adjusting for prespecified risk factors, cilostazol administration was a negative predictor of Re-ISR.
This small comparative study suggests that administering cilostazol for ISR lesions after femoropopliteal stenting reduces recurrent ISR.
研究在股腘段支架内再狭窄（ISR）治疗后应用西洛他唑是否对再发 ISR（Re-ISR）有积极影响。
检索多中心、回顾性、观察性注册数据库，以确定 2010 年 1 月至 2014 年 12 月期间对 379 条肢体的股腘段 ISR 进行腔内治疗的 338 例连续患者（平均年龄 72.3±8.8 岁；148 例男性）。排除 97 例（103 条肢体）在初始支架植入术后接受西洛他唑治疗的患者。这使得 24 例 ISR 患者（30 条肢体）在 ISR 治疗后最初接受西洛他唑治疗，与 217 例 ISR 患者（246 条肢体）未接受该药物治疗进行比较。主要终点为治疗后 2 年的 Re-ISR。次要终点为 2 年内的复发性靶病变血运重建（Re-TLR）和再闭塞。再狭窄通过双功能超声检查上的收缩期峰值速度比＞2.4 或血管造影上的＞50%狭窄来确定。
平均随访时间为 23.3±15.5 个月。在 2 年时，西洛他唑组的无 Re-ISR 率明显高于无西洛他唑组（48.6%比 32.4%，p=0.047）。然而，两组之间的无 Re-TLR 和再闭塞率没有显著差异[64.7%比 53.8%（p=0.15）和 88.3%比 73.9%（p=0.11）]。在调整了预设的危险因素后，西洛他唑的应用是 Re-ISR 的负预测因子。
这项小型比较研究表明，股腘段支架内再狭窄后应用西洛他唑治疗可降低再发 ISR。
