Tobita Kazuki, Takahara Mitsuyoshi, Iida Osamu, Soga Yoshimitsu, Yamaoka Terutoshi, Ichihashi Shigeo, Saito Shigeru
Department of Cardiology, Shonan Kamakura General Hospital.
Department of Diabetes Care Medicine and Department of Metabolic Medicine, Osaka University Graduate School of Medicine.
J Atheroscler Thromb. 2023 Oct 1;30(10):1461-1470. doi: 10.5551/jat.63874. Epub 2023 Feb 2.
The present study investigated the effects of additional cilostazol administration on the 12-month risk of restenosis after femoropopliteal heparin-bonded stent graft implantation.
This study was a sub-analysis of the Viabahn stent graft placement for femoropopliteal disease reQUIring endovaScular tHerapy (VANQUISH) study, which was a prospective multicenter study investigating patients who received Viabahn stent graft (W.L. Gore & Associates, Flagstaff, AZ, USA) and dual-antiplatelet therapy with aspirin and a thienopyridine. The comparison of clinical outcomes between subgroups with and without cilostazol treatment were performed using the propensity score-matching method to minimize the intergroup differences in baseline characteristics.
Cilostazol-treated patients had a lower 12-month proportion of restenosis than cilostazol-free patients (8.2% vs 27.3%). The odds ratio of cilostazol for the 12-month restenosis was 0.27 [95% CI, 0.08 to 0.97] (p=0.045). Furthermore, the cumulative incidence rates of surgical reconstruction, target lesion revascularization and acute thrombotic occlusion (p values by the log-rank test) were 2.6% versus 1.8% (P=0.43), 5.3% versus 20.5% (P=0.067), and 0.0% versus 11.8% (P=0.0499), respectively. The rates of surgical reconstruction and target lesion revascularization (TLR) were not significantly different between both groups.
Our study revealed the clinical impact of additional cilostazol treatment on the risk of restenosis and acute thrombotic occlusion following heparin-bonded stent graft implantation, while TLR and surgical reconstruction were not significantly different.
本研究调查了在股腘动脉肝素涂层支架植入术后额外给予西洛他唑对12个月再狭窄风险的影响。
本研究是股腘动脉疾病血管内治疗Viabahn支架植入（VANQUISH）研究的一项亚分析，该研究是一项前瞻性多中心研究，调查接受Viabahn支架（美国亚利桑那州弗拉格斯塔夫的W.L. Gore & Associates公司生产）以及阿司匹林和噻吩并吡啶双联抗血小板治疗的患者。使用倾向得分匹配法比较接受和未接受西洛他唑治疗的亚组之间的临床结局，以尽量减少组间基线特征差异。
接受西洛他唑治疗的患者12个月再狭窄比例低于未接受西洛他唑治疗的患者（8.2%对27.3%）。西洛他唑用于12个月再狭窄的比值比为0.27 [95%置信区间，0.08至0.97]（p = 0.045）。此外，手术重建、靶病变血管重建和急性血栓闭塞的累积发生率（对数秩检验p值）分别为2.6%对1.8%（P = 0.43）、5.3%对20.5%（P = 0.067）和0.0%对11.8%（P = 0.0499）。两组之间手术重建和靶病变血管重建（TLR）的发生率无显著差异。
我们的研究揭示了额外给予西洛他唑治疗对肝素涂层支架植入术后再狭窄和急性血栓闭塞风险的临床影响，而TLR和手术重建无显著差异。
