Cilostazol reduces restenosis after angioplasty in critical limb ischemia

By Piriya Mahendra, medwireNews Reporter

The quinolinone derivative cilostazol may be associated with reduced restenosis, reocclusion, and clinically driven target lesion revascularization (TLR) 3 months after infrapopliteal angioplasty, researchers say.

The retrospective analysis of 63 patients with critical limb ischemia and infrapopliteal lesions showed that binary restenosis and reocclusion rates were significantly lower 3 months after balloon angioplasty in those treated with cilostazol compared with those who were not, at 56.8% versus 86.0% and 20.5% versus 43.6%, respectively.

The rate of TLR was also significantly lower in the cilostazol group than in the noncilostazol group, at 27.5% versus 52.8%.

Y Soga (Kokura Memorial Hospital, Kitakyushu, Japan) and team say that cilostazol was effective at preventing restenosis, compared with no cilostazol, at a significant odds ratio of 0.22, whereas other antiplatelet agents, including aspirin and thienopyridine, did not show this effect.

Limb-based analysis revealed that there were no significant differences in reintervention, complete wound healing, or leg salvage between the cilostazol and noncilostazol groups. The authors say this finding indicates that further analysis is required to examine whether cilostazol improves clinical outcomes, in addition to reducing restenosis, in critical limb ischemia patients.

After adjustment for potential confounders including age, gender, hyperlipidemia, and aspirin and statin therapy, cilostazol was found to be significantly associated with reduced restenosis, reocclusion, and TLR, compared with no cilostazol, at respective odds ratios of 0.16, 0.25, and 0.25.

Previous studies have shown that cilostazol reduces restenosis and repeated revascularization in patients with femoropopliteal lesions after endovascular therapy. However, until now the drug's effect on infrapopliteal lesions after balloon angioplasty has been unclear.

"The effect of cilostazol on restenosis may result from the inhibition of neointimal hyperplasia," suggest Soga et al. "Cilostazol reduces restenosis due to suppression of migration and proliferation of vascular smooth muscle cells induced by platelet-derived growth factor. There may also be a vasodilation effect induced by the continuous relaxation of vascular smooth muscle."

The findings are published in the European Journal of Vascular and Endovascular Surgery.

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