Effect of cilostazol on in-stent neointimal hyperplasia after coronary artery stenting: a quantative coronary angiography and volumetric intravascular ultrasound study

• Published in: Circulation journal : official journal of the Japanese Circulation Society 2007-11, Vol.71 (11), p.1685-1690
• Main Authors: Min, Pil-Ki, Jung, Jae-Hun, Ko, Young-Guk, Choi, Donghoon, Jang, Yangsoo, Shim, Won-Heum
• Format: Article
• Language: English
• Subjects: Aged; Aspirin - therapeutic use; Cilostazol; Clopidogrel; Coronary Angiography; Coronary Disease - etiology; Coronary Disease - pathology; Coronary Disease - prevention & control; Coronary Vessels - diagnostic imaging; Coronary Vessels - pathology; Coronary Vessels - surgery; Drug Therapy, Combination; Female; Humans; Hyperplasia - etiology; Hyperplasia - pathology; Hyperplasia - prevention & control; Male; Middle Aged; Platelet Aggregation Inhibitors - therapeutic use; Prospective Studies; Stents - adverse effects; Tetrazoles - therapeutic use; Ticlopidine - analogs & derivatives; Ticlopidine - therapeutic use; Tunica Intima - drug effects; Tunica Intima - pathology; Ultrasonography, Interventional
• ISSN: 1346-9843

This study was designed to investigate the efficacy of cilostazol on the prevention of in-stent neointimal hyperplasia as measured by both quantitative coronary angiography (CAG) and volumetric intravascular ultrasound (IVUS). Fifty-nine patients (39 men, age 62 years) undergoing elective coronary stenting were randomly assigned to receive aspirin plus clopidogrel or ticlopidine (Group I, n=28, 30 lesions) or aspirin plus clopidogrel or ticlopidine plus cilostazol (Group II, n=31, 35 lesions). CAG and IVUS were performed and repeated at 6 months to assess the primary endpoints of minimal luminal diameter (MLD) and in-stent neointimal hyperplasia volume. Follow-up CAG was performed on all patients and follow-up IVUS study was available for 50 lesions in 48 patients (24 lesions in Group I, 26 in Group II). There were no significant differences in the baseline angiographic data between the 2 groups. At 6 months follow-up, in-stent MLD was 1.90+/-0.76 mm in Group I and 2.41+/-0.85 mm in Group II (p=0.006). Volumetric IVUS at 6 months demonstrated that in-stent intimal hyperplasia volume per stent length was 2.2+/-1.4 mm3/mm in Group I and 1.0+/-0.5 mm3/mm in Group II (p=0.001). Triple antiplatelet therapy including cilostazol seems to be more effective at preventing in-stent neointimal hyperplasia than a dual antiplatelet regimen.