scholarly journals Drug-Coated Balloon Angioplasty and Debulking for the Treatment of Femoropopliteal In-Stent Restenosis: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-14
Author(s):  
Zhu Tong ◽  
Lianrui Guo ◽  
Lixing Qi ◽  
Shijun Cui ◽  
Xixiang Gao ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
Balloon Angioplasty ◽  
Sequential Analysis ◽  
Meta Analysis ◽  
Trial Sequential Analysis ◽  
Cochrane Central Register ◽  
Stent Restenosis ◽  
Drug Coated Balloon ◽  
In Stent Restenosis

The purpose of this article was to compare the efficiency and safety of drug-coated balloon angioplasty (DCB) and atherectomy with percutaneous transluminal angioplasty (PTA) in patients with femoropopliteal in-stent restenosis (ISR). Pubmed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) (all up to March 2019) were searched systematically. Trial sequential analysis (TSA) was conducted. 5 studies with 599 participants were included. Compared with PTA, DCB significantly increased the rate of patency (6 months: RR 1.65, 95% CI 1.30 to 2.09, P<0.01; 12 months: RR 2.38, 95% CI 1.71 to 3.30, P<0.01) and the rate freedom from target lesion revascularization (TLR) (6 months: RR 1.18, 95% CI 1.09 to 1.28, P<0.01; 12 months: RR 1.56, 95% CI 1.33 to 1.82, P<0.01) at 6 and 12 months follow-up, and the TSA results showed these outcomes were reliable. The rate of clinical improvement by ≥1 Rutherford category in the DCB group was higher than that in the PTA group (6 months: RR 1.35, 95% CI 1.03 to 1.75, P=0.03; 12 months: RR 1.46, 95% CI 1.17 to 1.82, P<0.01) at 6 and 12 months. There is no statistically difference of ABI, all-cause mortality, and incidence of amputation between DCB group and PTA group (MD 0.03, 95% CI -0.03 to 0.08, P=0.40; RR 1.24, 95% CI 0.46 to 3.34, P=0.67; RR 0.32, 95% CI 0.01 to 7.61, P=0.48). Compared with PTA, the rate of patency and freedom from TLR in the laser atherectomy (LD) group was higher than that in the PTA group (patency: 6 months: RR 1.28, 95% CI 1.01 to 1.64, P<0.05, 12 months: RR 2.25, 95% CI 1.14 to 4.44, P<0.05; freedom from TLR: 6 months: RR 1.27, 95% CI 1.05 to 1.53, P=0.01, 12 months: RR 1.59, 95% CI 1.12 to 2.25, P=0.01) at 6 and 12 months follow-up. In conclusion, DCB and LD had superior clinical (freedom from TLR and clinical improvement) and angiographic outcomes (patency rate) compared with PTA for the treatment of femoropopliteal ISR. Moreover, DCB and LD had a low incidence of amputation and mortality and were relatively safe methods.

Drug-coated balloon angioplasty for in-stent restenosis of femoropopliteal arteries: a meta-analysis

2017 ◽  
Vol 13 (4) ◽  
pp. 483-489 ◽  
Author(s):  
Salvatore Cassese ◽  
Gjin Ndrepepa ◽  
Sebastian Kufner ◽  
Robert Byrne ◽  
Daniele Giacoppo ◽  
...  
Keyword(s):  
Balloon Angioplasty ◽  
Meta Analysis ◽  
Stent Restenosis ◽  
Drug Coated Balloon ◽  
In Stent Restenosis

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 TCTAP A-030 Drug Coated Balloon Versus Drug-eluting Stent for In-stent Restenosis After Drug-eluting Stent Implantation: A Meta-analysis

2021 ◽  
Vol 77 (14) ◽  
pp. S19
Author(s):  
Hendy Bhaskara Perdana Putra ◽  
Quri Meihaerani Savitri ◽  
Wally Wahyu Mukhammad ◽  
Atiyatum Billah ◽  
Alan Dharmasaputra ◽  
...  
Keyword(s):  
Stent Implantation ◽  
Meta Analysis ◽  
Drug Eluting Stent ◽  
Stent Restenosis ◽  
Drug Eluting ◽  
Drug Coated Balloon ◽  
In Stent Restenosis

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.

Republished: Endovascular recanalisation with drug coated balloon for chronic symptomatic middle cerebral artery total occlusion

2018 ◽  
Vol 10 (9) ◽  
pp. e24-e24 ◽  
Author(s):  
Jun Zhang ◽  
Xiao Zhang ◽  
Jin-Ping Zhang ◽  
Ju Han
Keyword(s):  
Middle Cerebral Artery ◽  
Medical Therapy ◽  
Cerebral Artery ◽  
De Novo ◽  
Total Occlusion ◽  
Good Outcome ◽  
Stent Restenosis ◽  
Drug Coated Balloon ◽  
In Stent Restenosis

The optimal treatment for patients with chronic symptomatic middle cerebral artery (MCA) total occlusion is not well established. In addition to medical therapy, vessel recanalisation with stenting has shown much promise, especially for patients with recurrent ischemic symptoms. Nevertheless, the incidence of symptomatic in-stent restenosis (ISR) is high, and is associated with an unfavorable prognosis. Drug coated balloons (DCBs) have been proven to be effective in treating and preventing ISR. However, the feasibility of DCBs for de novo intracranial atherothrombotic stenosis has not been previously described, especially for total occlusion lesions. Here we reported a patient with chronic left MCA total occlusion successfully treated with DCBs, with a good outcome at the 1 year follow-up. More studies are warranted to further compare the efficacy of DCBs and stentings for intracranial revascularisation.

Effect of Open- vs Closed-Cell Stent Design on Periprocedural Outcomes and Restenosis After Carotid Artery Stenting: A Systematic Review and Comprehensive Meta-analysis

2018 ◽  
Vol 25 (4) ◽  
pp. 523-533 ◽  
Author(s):  
Pavlos Texakalidis ◽  
Stefanos Giannopoulos ◽  
Damianos G. Kokkinidis ◽  
Giuseppe Lanzino
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Meta Analysis ◽  
Stent Design ◽  
Open Cell ◽  
Stent Restenosis ◽  
Closed Cell ◽  
Ischemic Attack ◽  
In Stent Restenosis

Purpose:To compare periprocedural complications and in-stent restenosis rates associated with open- vs closed-cell stent designs used in carotid artery stenting (CAS). Methods: A systematic search was conducted to identify all randomized and observational studies published in English up to October 31, 2017, that compared open- vs closed-cell stent designs in CAS. Identified studies were included if they reported the following outcomes: stroke, transient ischemic attack (TIA), myocardial infarction (MI), hemodynamic depression, new ischemic lesions detected on imaging, and death within 30 days, as well as the incidence of in-stent restenosis. A random-effects model meta-analysis was employed. Model results are reported as the odds ratio (OR) and 95% confidence interval (CI). The I2 statistic was used to assess heterogeneity. Results: Thirty-three studies (2 randomized trials) comprising 20, 291 patients (mean age 71.3±3.0 years; 74.6% men) were included. Patients in the open-cell stent group had a statistically significant lower risk of restenosis ⩾40% (OR 0.42, 95% CI 0.19 to 0.92; I2=0%) and ⩾70% (OR 0.23, 95% CI 0.10 to 0.52; I2=0%) at a mean follow-up of 24 months. No statistically significant differences were identified for periprocedural stroke, TIA, new ischemic lesions, MI, hemodynamic depression, or death within 30 days after CAS. Sensitivity analysis of the 2 randomized controlled trials only did not point to any significant differences either. Conclusion: Use of open-cell stent design in CAS is associated with a decreased risk for restenosis when compared to the closed-cell stent, without significant differences in periprocedural outcomes.

scholarly journals Traction Therapy for Cervical Radicular Syndrome is Statistically Significant but not Clinically Relevant for Pain Relief. A Systematic Literature Review with Meta-Analysis and Trial Sequential Analysis

2020 ◽  
Vol 9 (11) ◽  
pp. 3389
Author(s):  
Claudio Colombo ◽  
Stefano Salvioli ◽  
Silvia Gianola ◽  
Greta Castellini ◽  
Marco Testa
Keyword(s):  
Sequential Analysis ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Treatment Modalities ◽  
Trial Sequential Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Quality Of Evidence ◽  
Radicular Syndrome

Aim: We aimed to investigate the effectiveness of traction therapy in reducing pain by performing a systematic review with meta-analysis. We also explore the best modality for administering traction to patients with cervical radicular syndrome (CRS). Methods: We searched the Medline, Physiotherapy Evidence Database (PEDro), Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) electronic databases. Two reviewers independently selected randomized controlled trials (RCTs) that compared traction in addition to other treatments versus the effectiveness of other treatments alone for pain outcome. We calculated the mean differences (MDs) and 95% confidence intervals (CIs). We used Cochrane’s tool to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to evaluate the quality of evidence and summarize the study conclusions. Results: A total of seven studies (589 patients), one with low risk of bias, were evaluated. An overall estimate of treatment modalities showed low evidence that adding traction to other treatments is statistically significant (MD −5.93 [95% CI, −11.81 to −0.04] P = 0.05 and I2 = 57%) compared to other treatments alone. The subgroup analyses were still statistically significant only for mechanical and continuous modalities. Conclusions: Overall analysis showed that, compared to controls, reduction in pain intensity after traction therapy was achieved in patients with cervical radiculopathy. However, the quality of evidence was generally low and none of these effects were clinically meaningful.

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