During angioplasty, the most commonly used procedure in the U.S. to treat potentially life-threatening coronary blockages, a balloon- tipped catheter pushes aside atherosclerotic plaques in arteries. Once the vessel has been widened and adequate blood flow is returned, stents (tiny mesh wire tubes) are frequently used to keep arteries open. However, renarrowing has proved to be a frequent problem following angioplasty -- especially in diabetic patients.
Research presented today by Emory scientists at the American Heart Association's ( AHA) Scientific Sessions in New Orleans offers new hope that restenosis in diabetics undergoing coronary stenting can be significantly reduced with the drug cilostazol.
"The results of the CREST (Cilostazol for RESTenosis) trial, a multi-center study headed by Emory Heart Center cardiologist John S. Douglas, Jr., MD, established the ability of the anti-platelet agent cilostazol to reduce restenosis after coronary stenting. We studied the subset of diabetics in the CREST trial to evaluate their response to cilostazol after coronary stenting," says Emory Heart Center cardiology fellow Chandan M. Devireddy, MD, who presented the Emory researchers' abstract at the AHA meeting.
The Emory team identified CREST research subjects with diabetes and angiograms performed six months after angioplasty and stenting were analyzed to measure the in-segment restenosis rates of this sub-set of patients. The scientists identified the 139 diabetic patients that had enrolled in CREST. Angiograms performed six months after stent placement were studied to determinethe rate of in-stent restenosis.
There was a statistically significant decrease in restenosis in the diabetic patients receiving cilostazol over placebo (17.74vs. 37.66 percent). This benefit persisted even when selecting the diabetic patients with smaller vessel sizes(<2.75mm). "These patients are amongst the most challenging patients to achieve durable results with stenting. Thus, cilostazol may be an important tool in preventing restenosis in diabetic patients," Dr. Devireddy says.
Cilostazol (Pletal) is marketed by Otsuka America Pharmaceutical, Inc. with an indication for the treatment of intermittent claudication. Funding for the CREST study was provided by Otsuka America Pharmaceutical, Inc. in the form of an unrestricted research grant.