Outcomes with Cilostazol After Endovascular Therapy of Peripheral Artery Disease
Tuesday, May 21, 2019
Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)
Michael S Megaly, M.D.
,
Abbott Northwestern Hospital, Minneapolis Heart Institute, Minneapolis, MN
Bishoy Abraham, M.D.
,
Ascension St. John Hospital, st clair shores, MI
Marwan Saad, M.D., Ph.D.
,
Brown University Program, Warwick, RI
Andrew Mekaiel, MD
,
Jamaica Hospital Medical Center, Queens, NY
Peter A. Soukas, M.D., FSCAI
,
Cardiovascular Institute, Providence, RI
Subhash Banerjee, M.D., FSCAI
,
Dallas Veterans Affairs Medical Center, Dallas, TX
Mehdi H Shishehbor, DO, MPH, PhD, FSCAI
,
University Hospitals Harrington Heart & Vascular Institute, Cleveland, OH
Background:
The role of cilostazol after endovascular therapy (EVT) of peripheral artery disease (PAD) remains unclear.
Methods:
An electronic search was performed through November 2018 for all studies reporting the outcomes of cilostazol after EVT of PAD. A meta-analysis was conducted with the outcomes of interest including primary patency, major adverse limb events (MALE), target lesion revascularization (TLR), and major amputation.
Results:
We included eight studies (three randomized controlled trials (RCTs) and five observational studies) with a total of 3846 patients (4713 lesions). During a mean follow-up duration of 12.5±5 months, the use of cilostazol was associated with higher primary patency (OR 2.28, 95% CI (1.77, 2.94), p <0.001, I2=24%), lower risk of TLR (OR 0.37, 95% CI (0.26,0.52), p <0.001, I2=0%), lower risk of major amputation (OR 0.15, 95% CI (0.04- 0.62), p=0.008, I2=0 %), and a numerically lower risk of MALE (OR 0.51, 95% CI (0.26- 1.03), p=0.06, I2=57%). The use of cilostazol in RCTs was associated with significantly higher odds of primary patency compared with observational studies (OR 3.37 vs. 2.28, p interaction =0.03). After further subgroup analysis, cilostazol remained associated with higher primary patency regardless of the use of oral anticoagulants (p interaction=0.49).
Conclusions
The use of cilostazol after EVT of femoropopliteal and iliac lesions is associated with improved primary patency and lower risk of major amputation and target lesion revascularization. The favorable impact of cilostazol is independent of the use of oral anticoagulants or a specific thienopyridine.
