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

doi:10.11909/j.issn.1671-5411.2019.06.002

摘要：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.