Use of Cilostazol, a Novel Antiplatelet Agent, in a Post-Palmaz-Schatz Stenting Regimen

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Abstract

We evaluated the therapeutic efficacy of cilostazol, a novel potent inhibitor of phosphodiesterase, for the prevention of stent thrombosis following implantation of a Palmaz-Schatz stent guided by angiographic visual estimation alone in 71 patients with 84 lesions. Patients received 81 mg of aspirin 3 times daily and 100 mg of cilostazol twice daily after angiographic confirmation of optimal Palmaz-Schatz stent implantation. Of the 84 vessels stented, 65 (77%) were classified as type B2 or C lesions according to the modified American Heart Association/American College of Cardiology classification, and 51 (61%) were <3.0 mm in diameter. Multiple stents were used in 26 patients (31%). The final balloon inflation pressure was 18.3 ± 1.5 atm. The balloon-to-vessel ratio was 1.18 ± 0.16. No patient received heparin or warfarin after the procedure. There were no deaths, Q-wave myocardial infarctions, in- or out-of-hospital stent thrombosis, coronary bypass surgery, or serious side effects such as neutropenia and/or liver dysfunction during the 1-month follow-up period. These results indicate that cilostazol was a safe and effective antiplatelet agent with minimum side effects after Palmaz-Schatz stent implantation.

We evaluated the usefulness of cilostazol, a novel antiplatelet agent, for the prevention of stent thrombosis. No deaths, Q-wave myocardial infarctions, stent thrombosis, or serious side effects such as neutropenia occurred during the 1-month follow-up period, which suggests cilostazol is a safe and effective antiplatelet agent after Palmaz-Schatz stent implantation.

Section snippets

Methods

The study protocol was approved by our institute's ethics committee and was in accord with the principles of the Declaration of Helsinki. The possible risks and benefits of the new medication protocol were fully explained to each patient and his/her family, and written informed consent was obtained before the patients participated in the study.

Patient and Lesion Characteristics

Implantation of Palmaz-Schatz stents was attempted in 89 lesions of 76 patients. The stent was successfully deployed in 88 lesions of 75 patients. In 1 patient, a stent mounted on a Viva balloon failed to successfully cross the predilated stenosis located at the orifice of the left anterior descending artery. In 4 lesions of 4 patients, the stenting result was considered suboptimal because of dissection at the distal edge of the stent. They were also treated with aspirin and cilostazol after

Discussion

The results of this nonrandomized prospective study demonstrated that cilostazol is potentially useful as part of an antiplatelet regimen after Palmaz-Schatz stent implantation.

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