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Research Article
 
DOI:doi:10.11909/j.issn.1671-5411.2019.06.002
Drug-eluting balloons versus new generation drug-eluting stents for the management of in-stent restenosis: an updated meta-analysis of randomized studies
Lei GAO,Ya-Bin WANG,Jing JING,Ming ZHANG,Yun-Dai CHEN.Drug-eluting balloons versus new generation drug-eluting stents for the management of in-stent restenosis: An updated meta-analysis of randomized studiesJ Geriatr Cardiol 2019,16(6):448~457
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Authors:Lei GAO1;Ya-Bin WANG1;Jing JING1;Ming ZHANG1;Yun-Dai CHEN1

Author Affiliation:1.Department of Cardiology, Chinese PLA General Hospital, Beijing, China;

Foundation:

Abstract: Background New-generation drug-eluting stents (DES) was more effective in the treatment of in-stent restenosis (ISR) compared with the first-generation DES. Drug-eluting balloons (DEB) and new-generation DES had been available strategies in treatment of bare-metal stents/DES ISR (BMS/DES-ISR). Six new randomized trials have recently examined the angiographic outcomes and one-year clinical outcomes of DEB and new generation DES in BMS/DES-ISR. However, the optimal management for BMS/DES-ISR lesions remains controversial. Methods We searched the randomized clinical trials evaluating the angiographic outcomes and one-year clinical outcomes of DEB and new-generation DES in patients with BMS/DES-ISR. The primary endpoints were the angiographic outcomes, including the minimal luminal diameter (MLD), diameter stenosis % (DS%), late lumen loss (LLL), and binary restenosis (BR). Results A total of six randomized clinical trials with 1177 BMS/DES-ISR patients were included in our meta-analysis. For angiographic outcomes, there were significantly less MLD and more DS% with DEB compared to new-generation DES (MLD: MD = ?0.18, 95% CI: ?0.31– ?0.04, P < 0.001; DS%: MD = 5.68, 95% CI: 1.00–10.37, P < 0.001). Moreover, for one-year clinical outcomes, DEB was associated with a significant increase risk in target lesion revascularization (TLR) (RR = 2.93, 95% CI: 1.50–5.72, P = 0.002). However, DEB was associated with higher risks of major adverse cardiac event, target vessel revascularization, TLR, BR, and more DS% only in DES-ISR group. Conclusions DEB and new-generation DES have the similar clinical efficacy for the treatment of BMS-ISR. However, DES showed more MLD, less DS%, and a decreased risk of TLR for the treatment of DES-ISR.

Keywords:

Drug-eluting balloons; Drug-eluting stents; In-stent restenosis; Meta-analysis
Received:January 31, 2019        Accepted:May 15, 2019   Published Online:June 28, 2019
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