Mechanisms of balloon angioplasty and repeat stenting in patients with drug-eluting in-stent restenosis

Alfonso, Fernándo; Sandoval, Jorge; Pérez-Vizcayno, Marı́a José; Cárdenas, A.; Gonzalo, Nieves; Jiménez‐Quevedo, Pilar; Ibáñez, Borja; Núñez‐Gil, Iván J.; Rivero, Fernando; Escaned, Javier; Fernández‐Ortíz, Antonio; Macaya, Carlos

doi:10.1016/j.ijcard.2014.10.139

Cited by 9 publications

(7 citation statements)

References 34 publications

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“…In-stent implantation of drug eluting stents, providing additional permanent scaffolding inside the restenotic stent, 45 could overcome the mechanical limitations of drug coated balloons. Although the trials in our systematic review showed no significant differences in periprocedural complications and treatment crossover between drug coated balloons and drug eluting stents, repeated stenting with drug eluting stents might be a more reasonable indication for relevant periprocedural tissue protrusion and in-stent or stent edge dissection.…”

Section: Discussionmentioning

confidence: 99%

“…Drug eluting stents guarantee a larger, immediate minimum lumen diameter and more predictable acute effects at the risk of reiterating the process of neointimal growth. 45 48 The most relevant concern about drug coated balloons is the durability of the antirestenotic effect, because local drug use in the short term may not result in a longlasting inhibition of restenosis. However, the putative angiographic and clinical superiority of drug eluting stents in the long term for in-stent restenosis is presently not supported by a solid evidence basis.…”

Section: Discussionmentioning

confidence: 99%

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Treatment strategies for coronary in-stent restenosis: systematic review and hierarchical Bayesian network meta-analysis of 24 randomised trials and 4880 patients

Giacoppo

Gargiulo

Aruta

et al. 2015

BMJ

115

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Study queStionWhat is the most safe and effective interventional treatment for coronary in-stent restenosis? MethodSIn a hierarchical Bayesian network meta-analysis, PubMed, Embase, Scopus, Cochrane Library, Web of Science, ScienceDirect, and major scientific websites were screened up to 10 August 2015. Randomised controlled trials of patients with any type of coronary in-stent restenosis (either of bare metal stents or drug eluting stents; and either first or recurrent instances) were included. Trials including multiple treatments at the same time in the same group or comparing variants of the same intervention were excluded. Primary endpoints were target lesion revascularisation and late lumen loss, both at six to 12 months. The main analysis was complemented by network subanalyses, standard pairwise comparisons, and subgroup and sensitivity analyses. Study anSwer and liMitationSTwenty four trials (4880 patients), including seven interventional treatments, were identified. Compared with plain balloons, bare metal stents, brachytherapy, rotational atherectomy, and cutting balloons, drug coated balloons and drug eluting stents were associated with a reduced risk of target lesion revascularisation and major adverse cardiac events, and with reduced late lumen loss. Treatment ranking indicated that drug eluting stents had the highest probability (61.4%) of being the most effective for target lesion vascularisation; drug coated balloons were similarly indicated as the most effective treatment for late lumen loss (probability 70.3%). The comparative efficacy of drug coated balloons and drug eluting stents was similar for target lesion revascularisation (summary odds ratio 1.10, 95% credible interval 0.59 to 2.01) and late lumen loss reduction (mean difference in minimum lumen diameter 0.04 mm, 95% credible interval −0.20 to 0.10). Risks of death, myocardial infarction, and stent thrombosis were comparable across all treatments, but these analyses were limited by a low number of events. Trials had heterogeneity regarding investigation periods, baseline characteristics, and endpoint reporting, with a lack of information at long term follow-up. Direct and indirect evidence was also inconsistent for the comparison between drug eluting stents and drug coated balloons. what thiS Study addSCompared with other currently available interventional treatments for coronary in-stent restenosis, drug coated balloons and drug eluting stents are associated with superior clinical and angiographic outcomes, with a similar comparative efficacy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Treatment strategies for coronary in-stent restenosis: systematic review and hierarchical Bayesian network meta-analysis of 24 randomised trials and 4880 patients

Giacoppo

Gargiulo

Aruta

et al. 2015

BMJ

115

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“…The presence or absence of competitive flow has been correlated with the degree of vascular remodeling in jailed branches in the published literature 19 20. In the present study, we explored the effectiveness of the intravascular OCT technique in moderately or importantly remodeled jailed arteries.…”

Section: Discussionmentioning

confidence: 93%

Intravascular optical coherence tomography for the evaluation of arterial bifurcations covered by flow diverters

Iosif¹,

Saleme²,

Ponsonnard³

et al. 2016

J NeuroIntervent Surg

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“…Multiple stents need to be implanted due to diffuse lesions [32]. The total area of the stent metal material in contact with the blood vessel wall is large, which stimulates vascular endothelial hyperplasia and plaque formation, increasing the risk of ISR [33]. This study has found that stent diameter < 3 mm and stent length > 20 mm are risk factors for ISR, suggesting the importance of optimizing PCI.…”

Section: Discussionmentioning

confidence: 96%

The characteristics and risk factors of in-stent restenosis in patients with percutaneous coronary intervention: what can we do

Wang

Qiao

Wang

et al. 2020

BMC Cardiovasc Disord

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Background Percutaneous coronary intervention (PCI) is a common treatment for patients with coronary heart disease, and intra-stent restenosis (ISR) is a serious complication after PCI. It’s necessary to identify the potential risk factors to provide evidence for the prevention of ISR. Methods The patients who underwent coronary angiography 1 year after PCI in our hospital from January 2017 to May 2019 were selected. The characteristics and results of clinical examination of ISR and no-ISR patients were compared, Multivariate logistic regression analyses were performed to identify the risk factors. Results A total of 209 patients were included, the incidence of ISR after PCI was 30.62%. There were significant differences on the hypertension, diabetes, number of coronary artery lesions, reasons for stent implantation, the diameter of stent, the length of stent and stent position between ISR group and no-ISR patients (all p < 0.05). The LDL-C in ISR groups was significantly higher than that of no-ISR group (p = 0.048), there were no significant differences between two groups in FPG, TG, TC, HDL-C, Apo A1, Apo B, LP-a and glycated haemoglobin (all p > 0.05). The hypertension (OR 4.30, 95% CI 1.12–9.34), diabetes (OR 5.29, 95% CI 1.25–9.01), number of coronary artery lesions ≥ 2 (OR 4.84, 95% CI 1.21–9.55), LDL-C ≥ 1.9 mmol/L (OR 5.93, 95% CI 2.29–10.01), unstable angina (OR 2.92, 95% CI 1.20–4.55), left anterior descending artery (OR 4.01, 95% CI 1.73–7.58), diameter of stent ≥ 3 mm (OR 5.42, 95% CI 1.24–10.84), the length of stent > 20 mm (OR 3.06, 95% CI 1.19–5.22) were the independent risk factor for ISR (all p < 0.05). Conclusion It is necessary to take preventive measures against these risk factors to reduce ISR, and studies with larger sample size and longer follow-up on this issue are needed in the future.

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Mechanisms of balloon angioplasty and repeat stenting in patients with drug-eluting in-stent restenosis

Cited by 9 publications

References 34 publications

Treatment strategies for coronary in-stent restenosis: systematic review and hierarchical Bayesian network meta-analysis of 24 randomised trials and 4880 patients

Treatment strategies for coronary in-stent restenosis: systematic review and hierarchical Bayesian network meta-analysis of 24 randomised trials and 4880 patients

Intravascular optical coherence tomography for the evaluation of arterial bifurcations covered by flow diverters

The characteristics and risk factors of in-stent restenosis in patients with percutaneous coronary intervention: what can we do

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