Drug-eluting Balloon Versus Second Generation Drug Eluting Stents in the Treatment of In-stent Restenosis: A Systematic Review and Meta-analysis

Background. In-stent restenosis (ISR) remains a common problem following percutaneous coronary intervention (PCI). However, the best treatment strategy remains uncertain. There is some controversy over the efficacy of drug-eluting balloons (DEBs) and second-generation drug-eluting stents (DESs) for treating ISR. Methods. A meta-analysis was used to compare the efficacy of the DEB and second-generation DES in the treatment of ISR. The primary endpoint is the incidence of target lesion revascularization (TLR). The secondary endpoint is the occurrence of target vessel revascularization (TVR), myocardial infarction (MI), all-cause death (ACM), cardiac death (CD), major adverse cardiac events (MACEs), minimum luminal diameter (MLD), late luminal loss (LLL), binary restenosis (BR), and percent diameter stenosis (DS%). Results. A total of 12 studies (4 randomized controlled trials and 8 observational studies) including 2020 patients with a follow-up of 6–25 months were included in the present study. There was a significant difference in the MLD between the two groups during follow-up (P=0.007, RR = 0.23, and 95% CI: 0.06–0.4 mm). There was no significant difference in LLL, BR, or DS% and the overall incidence of MACEs between the two groups. Subgroup analysis showed no significant difference in the incidence of primary and secondary endpoints when considering RCTs or observational studies only. Conclusions. The efficacy of the DEB and second-generation DES in the treatment of ISR is comparable. However, our results need further verification through multicenter randomized controlled trials.

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GW29-e1432 Drug-eluting balloons versus second-generation drug-eluting Stents for treatment of in-stent restenosis in coronary heart disease after PCI: A Meta-analysis

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2018.08.610 ◽

2018 ◽

Vol 72 (16) ◽

pp. C128

Author(s):

WenJuan Xiu ◽

HaiTao Yang ◽

Xiang Xie

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Second Generation ◽

Meta Analysis ◽

Drug Eluting Stents ◽

Stent Restenosis ◽

Drug Eluting ◽

In Stent Restenosis

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Meta-Analysis Comparing the Frequency of Target Lesion Revascularization with Drug-Coated Balloons or Second-Generation Drug-Eluting Stents for Coronary In-Stent Restenosis

The American Journal of Cardiology ◽

10.1016/j.amjcard.2019.01.004 ◽

2019 ◽

Vol 123 (7) ◽

pp. 1186-1187 ◽

Cited By ~ 3

Author(s):

Islam Y. Elgendy ◽

Ahmed N. Mahmoud ◽

Akram Y. Elgendy ◽

Javier Cuesta ◽

Fernando Rivero ◽

...

Keyword(s):

Second Generation ◽

Meta Analysis ◽

Target Lesion ◽

Target Lesion Revascularization ◽

Drug Eluting Stents ◽

Stent Restenosis ◽

Drug Eluting ◽

In Stent Restenosis

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Drug-eluting balloon angioplasty for in-stent restenosis: a systematic review and meta-analysis of randomised controlled trials

Heart ◽

10.1136/heartjnl-2012-302945 ◽

2013 ◽

Vol 99 (5) ◽

pp. 327-333 ◽

Cited By ~ 67

Author(s):

Andreas Indermuehle ◽

Rahul Bahl ◽

Alexandra J Lansky ◽

Georg M Froehlich ◽

Guido Knapp ◽

...

Keyword(s):

Systematic Review ◽

Balloon Angioplasty ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Stent Restenosis ◽

Drug Eluting ◽

Drug Eluting Balloon ◽

Randomised Controlled ◽

In Stent Restenosis

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Abstract 340: Drug-Eluting Balloon Versus Everolimus-Eluting Stent for Restenosis in a Bare-Metal Stent: A Meta-Analysis of Randomized Trials

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.37.suppl_1.340 ◽

2017 ◽

Vol 37 (suppl_1) ◽

Author(s):

Akintunde M Akinjero ◽

Oluwole Adegbala ◽

Tomi Akinyemiju

Keyword(s):

Publication Bias ◽

Meta Analysis ◽

Bare Metal Stents ◽

Metal Stents ◽

Bare Metal ◽

Binary Restenosis ◽

Stent Restenosis ◽

Drug Eluting ◽

Drug Eluting Balloon ◽

In Stent Restenosis

Background: In-stent restenosis accounts for major morbidity and mortality among patients treated with Bare-Metal Stents (BMS). Early efforts to treat BMS in-stent restenosis with plain balloon angioplasty and first generation drug eluting stents (DES) have been ineffective, leaving drug-eluting balloon (DEB) and second generation DES, such as everolimus eluting stents (EES), as the only remaining options. For BMS in-stent restenosis, studies performed so far have yielded conflicting results, while prior meta-analyses have been influenced by inclusion of observational studies. This is the first meta-analysis to compare EES versus DEB using results from only randomized controlled trials (RCTs). Methods: A systematic search of PUBMED and EMBASE databases was conducted from first available date to August, 2016 for RCTs comparing DEB with EES. Two reviewers evaluated studies for eligibility and extracted data with binary restenosis rate as the main endpoint. We identified 901 unique citations. Odds ratios were pooled using random-effects modeling. Funnel plots were used to assess publication bias. Heterogeneity was assessed using I 2 statistic. All analysis were performed using Review Manager (RevMan) version 5.3 (Cochrane Collaboration, 2014). Results: Three RCTs met study eligibility criteria, with 684 patients and a mean follow-up of 9.5 months. There were 184 and 185 patients in the EES and DEB arms respectively. In pooled analyses, EES was not superior to DEB in binary restenosis rates (pooled odds ratio: 0.76; 95% confidence interval: 0.25-2.32; P=0.14). Heterogeneity was minimal (I 2 = 49%), and the funnel plot did not suggest publication bias. Conclusion: In patients with BMS in-stent restenosis, there were no significant differences in binary restenosis rates between EES and DEB. Our results can enhance physician decision-making regarding choice of revascularization tool in this patient population.

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