Clinical outcomes of percutaneous coronary intervention for de novo lesions in small coronary arteries: A systematic review and network meta-analysis

Abstract

BackgroundPercutaneous coronary intervention (PCI) has a well-established role in revascularization for coronary artery disease. We performed network meta-analysis to provide evidence on optimal intervention strategies for de novo lesions in small coronary arteries.Materials and methodsEnrolled studies were randomized clinical trials that compared different intervention strategies [balloon angioplasty (BA), biolimus-coated balloon (BCB), bare-metal stent (BMS), new-generation drug-eluting stent (New-DES), older generation sirolimus-eluting stent (Old-SES), paclitaxel-coated balloon (PCB), and paclitaxel-eluting stent (PES)] for de novo lesions in small coronary arteries. The primary outcome was major adverse cardiac events (MACE).ResultsA total of 23 randomized clinical trials comparing seven intervention devices were analyzed. In terms of the primary outcome, New-DES was the intervention device with the best efficacy [surface under the cumulative ranking curve (SUCRA), 89.1%; mean rank, 1.7], and the Old-SES [risk ratio (RR), 1.09; 95% confidence interval (CI), 0.45–2.64] and PCB (RR, 1.40; 95% CI, 0.72–2.74) secondary to New-DES, but there was no statistically significant difference between these three intervention devices. All DES and PCB were superior to BMS and BA for MACE in both primary and sensitivity analysis. For secondary outcomes, there was no association between all-cause mortality and myocardial infarction (MI) with any intervention strategy, and additionally, the findings of target lesion revascularization (TLR) were similar to the primary outcomes.ConclusionPaclitaxel-coated balloon yielded similar outcomes to New-DES for de novo lesions in small coronary arteries. Therefore, this network meta-analysis may provide potential support for PCB as a feasible, effective, and safe alternative intervention strategy for the revascularization of small coronary arteries.Systematic review registration[https://www.crd.york.ac.uk/PROSPERO/#recordDetails], identifier [CRD42022338433].

Magnesium bioresorbable scaffold (Magmaris) versus polymer biodegradable ultrathin drug-eluting stent (Ultimaster) in acute coronary syndrome. Mid-term outcomes (2 years)

“…Data regarding the long-term evaluation of Magmaris BRS are rather sparse and mainly originate from retrospective observational clinical registries [ 20 , 27 – 29 ]. Based on this single-arm evaluation despite all of its methodological shortcomings Magmaris showed favorable long-term safety and clinical performance with acceptable target lesion failure rates (5.2% up to 11%), which is comparable to our findings (5.6%) and analogous to novel DES performance [ 30 – 32 ]. Also in our study, we did not note significant differences between the Magmaris and Ultimaster DES in terms of TLF (5.6% vs. 8.0, p = 0.41).…”

Atherosclerotic-Derived Endothelial Cell Response Conducted by Titanium Oxide Nanotubes

“…Far more critical is when a rupture of the atherosclerotic plaques takes place, exacerbating myocardial infarctions, strokes, and in the worst scenario, death. The catheter-based angioplasty followed by stenting implantation is the gold standard intervention for the revascularization and treatment of atherosclerotic lesions [ 6 , 7 ]. However, the angioplasty and the stent colocation process led to significant damage and alterations of the surrounding endothelial cells [ 8 , 9 , 10 ].…”

Atherosclerotic-derived endothelial cell response conducted by titanium oxide nanotubes

“…Far more critical is when rupture of the atherosclerotic plaques takes place, exacerbates myocardial infarctions, strokes, and in the worst scenario, death. The catheter-based angioplasty followed by stenting implantation is the gold standard intervention for the revascularization and treatment of atherosclerotic lesions [4,5]. However, the angioplasty and the stent colocation process lead to significant damage and alterations of the surrounding endothelial cells [6][7][8].…”