Systemic
vascular disease is the greatest cause of mortality in the western world. Treatment options have been preventative with medical
therapy or curative with surgical bypass. Recently, there has been an increase in the use and popularity of minimally invasive
endovascular techniques, particularly angioplasty and
stent insertions. The short-term results of these techniques have been demonstrated to be superior in a number of studies when compared with conventional surgery, which itself carries high mortality and morbidity. The long-term outcomes of endovascular treatments have not been as impressive, due to vascular restenosis caused mainly by intimal
hyperplasia. There have been a large number of studies and therapeutic trials to discover a
solution to restenosis, but to date success has not been reached.
Cilostazol is a
phosphodiesterase inhibitor licensed for treating patients suffering from
intermittent claudication. Recent clinical trials have shown the effects of
cilostazol in also preventing coronary artery restenosis post-endovascular treatments. These results have recently been repeated for peripheral vascular
stents. This review discusses the pharmacology of
cilostazol,
peripheral vascular disease, mechanisms of intimal
hyperplasia causing vascular restenosis. We also discuss the use of
cilostazol and other current patents of novel targets and
therapeutics, for preventing restenosis of both coronary and
peripheral arterial disease following endovascular
therapies.