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Updated: May 9, 2026
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Differential impact of cilostazol on restenosis according to implanted stent type (from a pooled analysis of three
Seung-Whan Lee1, Jung-Min Ahn, Seungbong Han
1Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Insights
Triple-antiplatelet therapy including cilostazol significantly reduced restenosis after drug-eluting stent implantation, especially with sirolimus-eluting stents. This highlights cilostazol
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pharmacology
Background:
- Restenosis remains a challenge post-drug-eluting stent (DES) implantation, particularly for complex coronary lesions.
- Optimizing antiplatelet therapy is crucial for improving outcomes in patients at high risk for restenosis.
Purpose of the Study:
- To evaluate the differential efficacy of add-on cilostazol in reducing restenosis based on the type of DES implanted.
- To assess the impact of triple-antiplatelet therapy (TAT) versus dual-antiplatelet therapy (DAPT) on restenosis rates across different DES types.
Main Methods:
- Pooled patient-level data from three randomized trials (DECLARE-DIABETES, DECLARE-LONG I & II) involving 1,399 patients.
- Patients received sirolimus-eluting stents (SES), paclitaxel-eluting stents (PES), or zotarolimus-eluting stents (ZES).
- Comparison of restenosis rates between TAT (aspirin, clopidogrel, cilostazol) and DAPT (aspirin, clopidogrel), stratified by stent type.
Main Results:
- TAT significantly reduced in-stent late loss compared to DAPT across all stent types.
- In-segment restenosis was significantly lower with TAT for SES (0.5% vs 6.7%) and ZES (12.2% vs 20.0%), but not PES (14.4% vs 20.0%).
- A significant interaction between stent type and antiplatelet regimen for restenosis risk (p=0.004) was observed, with the greatest benefit from TAT seen with SES.
Conclusions:
- Add-on cilostazol in TAT effectively reduces restenosis in high-risk patients, particularly those treated with SES.
- The findings suggest sustained utility of cilostazol therapy with newer generation DES, showing comparable efficacy to SES.
- Stent type influences the effectiveness of add-on cilostazol in preventing restenosis.
Abstract:
Even in the drug-eluting stent era, restenosis has remained an unresolved issue, particularly in the treatment of complex coronary lesions. In this study, patient-level data from 3 randomized trials (Drug-Eluting Stenting Followed by Cilostazol Treatment Reduces Late Restenosis in Patients With Diabetes Mellitus [DECLARE-DIABETES] and Drug-Eluting Stenting Followed by Cilostazol Treatment Reduces Late Restenosis in Patients With Long Native Coronary Lesions [DECLARE-LONG] I and II) were pooled to estimate the differential antirestenotic efficacy of add-on cilostazol according to the implanted drug-eluting stent in patients at high risk for restenosis. A total of 1,399 patients underwent sirolimus-eluting stent (SES; n = 450), paclitaxel-eluting stent (n = 450), and zotarolimus-eluting stent (n = 499) implantation and received triple-antiplatelet therapy (TAT; aspirin, clopidogrel, and cilostazol, n = 700) and dual-antiplatelet therapy (aspirin and clopidogrel, n = 699). Randomization of antiplatelet regimen was stratified by stent type. In-stent late loss after TAT was significantly lower than that after dual-antiplatelet therapy, regardless of implanted stent type. However, the incidence of in-segment restenosis after TAT was significantly lower with SES (0.5% vs 6.7%, p = 0.014) and zotarolimus-eluting stent (12.2% vs 20.0%, p = 0.028) implantation but not paclitaxel-eluting stent implantation (14.4% vs 20.0%, p = 0.244). A significant interaction was present between stent type and antiplatelet regimen for the risk for in-segment restenosis (p = 0.004). Post hoc analysis using bootstrap resampling methods showed that the relative risk reduction for in-segment restenosis after TAT was most prominent with SES implantation. In conclusion, add-on cilostazol effectively reduced restenosis in patients at high risk for restenosis, particularly in those receiving SES, suggesting the sustainable utility of add-on cilostazol therapy in newer generation drug-eluting stents with comparable efficacy with that of SES.
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