Long term outcomes of new generation drug eluting stents versus coronary artery bypass grafting for multivessel and/or left main coronary artery disease. A Bayesian network meta-analysis of randomized controlled trials

Mina, George; Watti, Hussam; Soliman, Demiana; Shewale, Anand R.; Atkins, Jessica; Reddy, Pratap; Dominic, Paari

doi:10.1016/j.carrev.2018.01.003

Cited by 5 publications

(4 citation statements)

References 33 publications

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“…While there is heterogeneity in the stent technology employed in studies over the years, the meta-analysis data demonstrate that DES, even of the newer generation, do not consistently outperform prior generations of stents or CABG. 16,18,20,30,32 While new DES options tend to garner more attention, the performance of CABG patients has also improved with time, and this is multifactorial in nature. 49 There have been advances in surgical technique such as multiarterial revascularization, in addition to minimally invasive, beating heart, and off pump approaches.…”

Section: Discussionmentioning

confidence: 99%

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Percutaneous Coronary Intervention with Stenting versus Coronary Artery Bypass Grafting in Stable Coronary Artery Disease

2021

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The debate over coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) with stent placement for the treatment of stable multivessel coronary artery disease (CAD) continues in spite of numerous studies investigating the issue. This paper reviews the most recent randomized control trials (RCT) and meta-analyses of pooled RCT data to help address this issue. General trends demonstrated that CABG was superior in all-cause mortality and fulfilling the need for repeat revascularization. These advantages tended to be more pronounced in multivessel CAD and diabetes, and less so in left main CAD. PCI showed a consistently lower rate of cerebrovascular events. CABG continues to offer significant advantages over PCI, even as drug-eluting stent technology continues to evolve. The ideal endpoint for comparing PCI and CABG remains to be determined. Furthermore, additional research is required to further refine patient selection criteria for each intervention.

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Section: Discussionmentioning

confidence: 99%

“…16,17,24 -A large body of data consistently demonstrate that rates of target vessel revascularization are significantly lower among CABG patients. [15][16][17][21][22][23][24][28][29][30][31][32] This includes repeat intervention in the form of both PCI and CABG. -One factor which has consistently favored PCI is lower rates of stroke.…”

Section: Meta-analysismentioning

confidence: 99%

Percutaneous Coronary Intervention with Stenting versus Coronary Artery Bypass Grafting in Stable Coronary Artery Disease

2021

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“…Drug eluting stent (DES) implantation is the first choice of treatment in PCI. The dramatic ability of DES to inhibit neointimal hyperplasia through sustained elution of cytostatic drugs significantly reduced repeat revascularization rate in clinical trials . However, DES exhibits some device‐associated features and shortcomings for treating in‐stent restenosis (ISR), coronary small‐vessel disease (SVD), and coronary bifurcation disease .…”

Section: Introductionmentioning

confidence: 99%

“…sustained elution of cytostatic drugs significantly reduced repeat revascularization rate in clinical trials. 1,2 However, DES exhibits some device-associated features and shortcomings for treating in-stent restenosis (ISR), coronary small-vessel disease (SVD), and coronary bifurcation disease. 3 What's more, a consistent risk of late adverse events mainly caused by ISR still remains a major concern after the deployment of DES.…”

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confidence: 99%

Ultrasound controlled paclitaxel releasing system—A novel method for improving the availability of coronary artery drug coated balloon

Song

Zhou

Zhang³

et al. 2019

Cathet Cardio Intervent

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Objectives: The aim of this study is to improve local-drug delivery efficiency and tissue absorption using the ultrasound (US)-responsible drug coating based on a newly developed US-controlled paclitaxel release balloon. Background: Low availability of the drug coating remains a major concern of the current drug coated balloon (DCB). The goal of this study is to develop a method to use an US-responsible paclitaxel-loaded microcapsules (PM) as the main content of balloon drug coating to enhance bioavailability of DCB. Methods: An US-controlled paclitaxel release balloon is designed and fabricated based on the US-responsible paclitaxel-loaded poly (lactic-co-glycolic acid) (PLGA) microcapsules. Rapid exchange percutaneous transluminal coronary angioplasty (PTCA) balloon catheters were coated with the PM. The deployment processes of the paclitaxel-loaded microcapsules coated balloons (PMCB) under US, PMCB without US and a homogenous matrix of paclitaxel and iopromide coated balloon (PICB) were then placed in healthy and stent implanted porcine coronary arteries. Results: In vitro release assay demonstrated an ability of US (1 MHz, 1.22 W/cm 2 , 1 minute) to affect the release kinetics of paclitaxel from PM by inducing a 76 ± 5.4% increase in the rate of release. The paclitaxel content in target vessels are 203 ± 37 μg/g for PMCB under US, 85 ± 23 μg/g for PMCB without US, and 107 ± 31 μg/g for PICB 1-hr post-surgery. The availability of the drug for the PMCB reaches 27% under US. Conclusions: The US-controlled paclitaxel release balloon significantly improved the drug content of the target vessels in the porcine model. K E Y W O R D S controlled drug release, drug coated balloon, paclitaxel, pharmacokinetics, PLGA microcapsules, US 1 | INTRODUCTION In recent decades, the outcomes of coronary heart disease (CHD) have markedly improved, which can be partly attributed to the evolution of percutaneous coronary intervention (PCI). From percutaneous transluminal coronary angioplasty to bare-metal stent and then to drugeluting stent, every step of PCI is attractive to interventional cardiologist, great progress has been made for patients with CHD. Drug eluting stent (DES) implantation is the first choice of treatment in PCI. The dramatic ability of DES to inhibit neointimal hyperplasia through

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Intervencionismo coronario percutáneo en pacientes con enfermedad del tronco coronario izquierdo o enfermedad multivaso

Lara-García,

Moreno,

de la Torre-Hernández

et al. 2024

REC: CardioClinics

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Long term outcomes of new generation drug eluting stents versus coronary artery bypass grafting for multivessel and/or left main coronary artery disease. A Bayesian network meta-analysis of randomized controlled trials

Cited by 5 publications

References 33 publications

Percutaneous Coronary Intervention with Stenting versus Coronary Artery Bypass Grafting in Stable Coronary Artery Disease

Percutaneous Coronary Intervention with Stenting versus Coronary Artery Bypass Grafting in Stable Coronary Artery Disease

Ultrasound controlled paclitaxel releasing system—A novel method for improving the availability of coronary artery drug coated balloon

Intervencionismo coronario percutáneo en pacientes con enfermedad del tronco coronario izquierdo o enfermedad multivaso

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