scholarly journals Drug-Eluting Balloons versus Second-Generation Drug-Eluting Stents for Treating In-Stent Restenosis in Coronary Heart Disease after PCI: A Meta-Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-14 ◽  
Author(s):  
Wen-Juan Xiu ◽  
Hai-Tao Yang ◽  
Ying-Ying Zheng ◽  
Yi-Tong Ma ◽  
Xiang Xie
Keyword(s):  
Observational Studies ◽  
Second Generation ◽  
Meta Analysis ◽  
Drug Eluting Stents ◽  
Randomized Controlled ◽  
Stent Restenosis ◽  
Significant Difference ◽  
Drug Eluting ◽  
In Stent Restenosis

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.

scholarly journals The incidence of in-stent restenosis after drug-eluting stent implantation in patients on chronic hemodialysis

2020 ◽  
Author(s):  
Masayuki Motohiro ◽  
Hiroshi Sugita ◽  
Hiroki Shibutani ◽  
Syun Morishita ◽  
Masami Tanaka ◽  
...  
Keyword(s):  
Stent Implantation ◽  
Second Generation ◽  
Chronic Hemodialysis ◽  
Rotational Atherectomy ◽  
Drug Eluting Stents ◽  
Drug Eluting Stent ◽  
Stent Restenosis ◽  
Significant Difference ◽  
Drug Eluting ◽  
In Stent Restenosis

Abstract Background: Recently, drug-eluting stents have been widely adopted rather than bare-metal stents in patients on chronic hemodialysis (HD) based on the extrapolation of data from patients on non-HD. However, whether DES implantation is associated with a reduced rate of in-stent restenosis (ISR) is unclear. We investigated the incidence of ISR and its predictors in patients on HD after drug-eluting stent implantation.Methods and Results: We analyzed 194 consecutive patients (331 lesions) on HD who underwent follow-up angiography after drug-eluting stent implantation. ISR was observed in 74 lesions (22.4%). Angiographically, the relative incidence of AHA/ACC type C lesion was increased (47% vs. 32%; P=0.043), the minimal lumen diameter (MLD) before DES implantation was smaller (0.82±0.49 vs. 0.97±0.45mm; P<0.01) and the lesion length (LL) was increased (30.2±16.1 vs. 24.4±12.1mm; P=0.023) in lesions with ISR compared to those without ISR. The rate of rotational atherectomy use was also increased in lesions with ISR compared to those without ISR (50% vs. 25%; P<0.01). In a multivariate analysis, the MLD before drug-eluting stent implantation (odds ratio [OR] =0.50, 95% confidence interval [CI] 0.27-0.91, P=0.024), LL (OR=1.02, 95% CI 1.00-1.04, P=0.030) and the use of rotational atherectomy (OR=2.71, 95% CI 1.55-4.72, P<0.01) were independent predictors of ISR. The incidence of ISR was similar between lesions treated with the first-generation (25.8%) and the second-generation DESs (20.4%).Conclusion: ISR was observed in 74 lesions (22.4%). A small MLD, long LL and the use of rotational atherectomy were independent predictors of ISR after drug-eluting stent implantation in patients on HD. There was no significant difference in ISR rate between the first- and the second-generation drug-eluting stents.

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

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e017231 ◽  
Author(s):  
Jin-Zan Cai ◽  
Yong-Xiang Zhu ◽  
Xin-Yu Wang ◽  
Christos V Bourantas ◽  
Javaid Iqbal ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Death ◽  
Meta Analysis ◽  
Drug Eluting Stents ◽  
Stent Restenosis ◽  
Drug Eluting ◽  
New Generation ◽  
Drug Coated Balloon ◽  
In Stent Restenosis

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.

scholarly journals Inverse Relationship between Serum VEGF Levels and Late In-Stent Restenosis of Drug-Eluting Stents

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Jiasheng Yin ◽  
Li Shen ◽  
Meng Ji ◽  
Yizhe Wu ◽  
Sishi Cai ◽  
...  
Keyword(s):  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Pathological Process ◽  
Drug Eluting Stents ◽  
Stent Restenosis ◽  
Significant Difference ◽  
Drug Eluting ◽  
Endothelial Growth Factor ◽  
In Stent Restenosis

Late in-stent restenosis (ISR) has raised concerns regarding the long-term efficacy of drug-eluting stents (DES). The role of vascular endothelial growth factor (VEGF) in the pathological process of ISR is controversial. This retrospective study aimed to investigate the relationship between serum VEGF levels and late ISR in patients with DES implantation. A total of 158 patients who underwent angiography follow-up beyond 1 year after intervention were included. The study population was classified into ISR and non-ISR groups. The ISR group was further divided according to follow-up duration and Mehran classification. VEGF levels were significantly lower in the ISR group than in the non-ISR group [96.34 (48.18, 174.14) versus 179.14 (93.59, 307.74) pg/mL, p<0.0001]. Multivariate regression revealed that VEGF level, procedure age, and low-density lipoprotein cholesterol were independent risk factors for late ISR formation. Subgroup analysis demonstrated that VEGF levels were even lower in the very late (≥5 years) and diffuse ISR group (Mehran patterns II, III, and IV) than in the late ISR group (1–4 years) and the focal ISR group (Mehran pattern I), respectively. Furthermore, significant difference was found between diffuse and focal ISR groups. Serum VEGF levels were inversely associated with late ISR after DES implantation.

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