Comparison of new-generation drug-eluting stents versus drug-coated balloon for in-stent restenosis: a meta-analysis of randomised controlled trials

Abstract

ObjectiveThe study sought to compare angiographic and clinical outcomes of new-generation drug-eluting stents (DES) versus drug-coated balloon (DCB) in patients with coronary in-stent restenosis (ISR).DesignMeta-analysis using data from randomised trial found by searches on PubMed, the Cochrane Library, ClinicalTrials.gov and websites of major cardiovascular congresses.SettingOnly randomised trials comparing DES with DCB were included.ParticipantsPatients with ISR in the included trials.InterventionsNew-generation DES versus DCB.OutcomesThe angiographic and clinical outcomes including cardiac death, all-cause death, myocardial infarction, target lesion revascularisation (TLR), target vessel revascularisation (TVR), major adverse cardiac events (MACE) and stent thrombosis were investigated.ResultsFive trials including 913 patients were eligible and included. Pooled analysis in angiographic results identified that new-generation DES were associated with higher acute luminal gain (−0.31 mm, 95% CI −0.42 to −0.20, P<0.001) and lower per cent diameter stenosis (risk ratio (RR): 0.28, 95% CI 0.02 to 0.55, P=0.04). DES significantly reduced the risk of TLR (RR: 1.96, 95% CI 1.17 to 3.28, P=0.01) compared with DCB; however, there was no statistical differences for MACE (RR: 1.21, 95% CI 0.67 to 2.17, P=0.53), myocardial infarction (RR: 1.16, 95% CI 0.55 to 2.48, P=0.69) and cardiac death (RR: 1.80, 95% CI 0.60 to 5.39, P=0.29).ConclusionsInterventions with new-generation DES appear to be associated with significant reduction in per cent diameter stenosis and TLR at short-term follow-up, but had similar MACE, myocardial infarction and cardiac death for patients with coronary ISR compared with DCB. Appropriately powered studies with longer term follow-up are warranted to confirm these findings.

Drug-coated Balloons for Small Coronary Vessel Interventions: A Literature Review

“…The DCB technique has been successfully tested in ISR, where good clinical efficacy was demonstrated in most studies, but not in all. [15,16,32–39] Current guidelines recommend the use of DCBs for patients with coronary ISR (class I, level of evidence A). [1,40] In addition, DCBs are now increasingly being seen as an attractive option for the treatment of SVD and bifurcation lesions.…”

Long‐term outcome of brachytherapy treatment for coronary in‐stent restenosis: Ten‐year follow‐up

“…A recent meta‐analysis of randomized controlled studies comparing both strategies suggested that interventions with new‐generation DES appear to be associated with significant reduction in per cent diameter stenosis and TLR at short‐term follow‐up, but had similar MACE, MI and cardiac death for patients with ISR compared with DCB …”

Carotid–vertebral artery bypass with saphenous vein graft for symptomatic vertebrobasilar insufficiency

“…In clinical practice, the rate of in-stent restenosis 5 years after percutaneous coronary interventions has been reported to be nearly 5% for patients treated with drug-eluting stents and 10% for patients treated with bare metal stents. 5 For the VA, the incidence varies among different studies from 0% to more than 50% due to heterogeneity in study designs, types of stents, follow-up times, and evaluation methods. 9 The incidence of symptomatic severe in-stent restenosis is unknown, but, in such patients, it is very difficult to perform balloon dilation or a second stent placement in the area with restenosis, as the first stent sometimes protrudes to the lumen of the ScA for approximately 2-3 mm and forms a sharp angle with the ScA.…”