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Abstract

We thank Dr Sharma and his colleagues for their interest in our article and appreciate their taking the time to address this important correspondence. We would like to respond to the several comments they have made. As Dr Sharma correctly points out, the patient demographics in our article included an inadvertent error regarding gender. We misplaced male with female in our manuscript. Indeed, most of the patients were men: 70% (44 of 63) in the cilostazol group and 75% (48 and 64) in the ticlopidine group, which is similar to the Western world. The comments raised by the correspondents regarding statins are interesting. It is true that relatively fewer patients were taking statins compared with the Western populations. Unlike in North America and Europe, our vascular patient population did not include many of the severest forms of hypercholesterolemia. In fact, the average low-density lipoprotein level was 114 mg/dL in the cilostazol group and 119 mg/dL in the ticlopidine group. We additionally analyzed the duration of statin therapy, which was not significantly different between the cilostazol and the ticlopidine groups (data not shown). Subgroup analysis has also been performed to compare those taking statins and cilostazol and those taking cilostazol without statins. Restenosis and primary patency rates at 12, 24, and 36 months were not significantly different between the groups (data not shown). These rates may be different in vascular patient populations with more severe forms of hypercholesterolemia in Western countries. Adverse events in this study included death, amputation, and restenosis, which were broken down, respectively, as 4, 4, and 15 in the cilostazol group and 6, 1, and 27 in the ticlopidine group. These adverse events were significantly infrequent in the cilostazol group compared with the ticlopidine group, as shown by Kaplan-Meier survival with log-rank testing (Fig 4). Regarding the interventional procedures, frequencies of stent use were similar between the cilostazol group (89%, 56 patients) and the ticlopidine group (84%, 54 patients). Seventeen patients who did not have stents were treated with angioplasty alone. Among these, patency rates were similar between the cilostazol group (89%, 74%, and 74% at 12, 24, and 36 months) and the ticlopidine group (75%, 63% and 63% at 12, 24, and 36 months, P = .53). Thus, we believe the conclusion reached in our article, that cilostazol contributed to the reduction of restenosis rate, particularly after the endovascular therapy using self-expanding stents, remains valid, at least in our vascular patient population. Regarding “Cilostazol reduces restenosis after endovascular therapy in patients with femoropopliteal lesions”Journal of Vascular SurgeryVol. 48Issue 5PreviewWe were delighted to read the recent publication by Iida et al1 showing that cilostazol significantly reduces restenosis in patients with femoropopliteal lesions after endovascular therapy. When looking closely at their results with a view to applying them to our practice in England, we have a few questions. Full-Text PDF Open Archive