Mitchell S.V. Elkind, M.D., is American Heart Association president-elect, chair of the Advisory Committee of the American Stroke Association — a division of the American Heart Association and professor of neurology and epidemiology at Columbia University New York. 

copyright American Heart Association

"The Cascara Study looks at the benefits the potential benefits of adding Cilostazol to antiplatelet therapy in patients who are undergoing Carotid artery stenting. A Carotid artery stenting is being done frequently now for patients with both symptomatic and asymptomatic carotid stenosis, and it's still not clear what the best way is to prevent the vessel from restenosing. So, after the vessel is opened, it can close back down again and so, obviously we'd like to be able to prevent that if possible. And so, this group of investigator use an agent Cilostazol that isn't often used in the United States in the setting of stroke, but has been used in some other countries, it is used for Peripheral Arterial Disease, and it may have many benefits on the vessel wall that lead to its ability to reduce restenosis. And so, they tested whether adding Cilostazol to other agents and they let investigators choose which other agents they might use whether Cilostazol in addition would provide some extra benefit. 

They did find that there were some benefit to adding Cilostazol, and this is perhaps an exciting result with the degree of stenosis restenosis dropping from about 15% to about 9% or so. However, the results were not statistically significant. So, we've seen other trials with Cilostazol in a setting of stroke and there's some evidence, benefit, other trials haven't confirm that, it's not often used again in the United States, although other countries are more enthusiastic about using it, and so, it's a great thing to have available in the armamentarium, but we're not yet using it routinely certainly not in patients with stents.

These results may prompt further study in this area. Stenting for carotid artery disease, is itself something that we do when patients can't undergo surgery. For example, either because they have a condition that made surgery difficult, or anesthesia difficult, or if their anatomy of the carotid artery doesn't lend itself to a surgical approach. Stenting can be used in those situations. Trials, though have shown that in most cases, carotid surgery is a good strategy. And so, again the generalize ability of these results to patients who have carotid stenosis maybe limited for that reason."