Comparison of drug-eluting balloon with repeat drug-eluting stent for recurrent drug-eluting stent in-stent restenosis

Abstract

ObjectiveApproximately, 10–20% of patients with drug eluting stent (DES) in-stent restenosis (ISR) will develop recurrent ISR; yet, the optimal management of recurrent DES-ISR is unknown. We sought to compare the outcomes of recurrent DES-ISR treated with drug eluting balloons (DEB) to those with repeated implantation of new-generation DES.MethodsA total of 172 patients with recurrent DES-ISR were enrolled and stratified into two cohorts: the repeated DES implantation (Re-DES) group and the DEB group. The primary endpoint was the 1-year incidence of major adverse cardiovascular events (MACE).ResultsNinety-three patients treated with DEB and 79 patients with Re-DES implantation were analyzed. Both groups had comparable baseline characteristics. Lesser residual stenosis was achieved in the Re-DES group (11.3 ± 3.2% vs. 22.4 ± 4.3%; P = 0.00) than in the DEB group. However, the incidence of MACE and target lesion revascularization (TLR) were less in the DEB group (17.2% vs. 32.9%; P = 0.02 and 15.1% vs. 27.8%; P = 0.04, respectively). For the ≥3 metal-layered DES-ISR subgroup, DEB drastically reduced the incidences of MACE and TLR compared with Re-DES (20.0% vs. 57.9%; P = 0.02 and 16.0% vs. 47.4%; P = 0.04, respectively). Survival analysis demonstrated that MACE-free survival was significantly higher in the DEB group compared with the Re-DES group, whether the metal layers were ≥3 or 2. Multivariate analysis revealed that the risk factors of MACE were diabetes mellitus, ≥3 metal-layered DES ISR, and repeat DES deployment.ConclusionsFor recurrent DES-ISR, DEB may improve clinical outcomes compared with Re-DES implantation, especially for ≥3 metal-layered DES-ISR.

Long-term outcomes following drug-eluting balloons vs. thin-strut drug-eluting stents for treatment of recurrent restenosis in drug-eluting stents

“…Similar to our findings, a signal toward the superiority of DES compared with DEB was observed in the previously mentioned study by Kawamoto et al [11] (27.7 vs. 38.3% of TLR at 2 years respectively), which did not meet statistical significance, possibly due to smaller sample size. On the other hand, in a report by Wang et al [14] (n = 172), the 1-year incidence of TLR was significantly higher after DES compared with DEB (27.8 vs. 15.1%; P = 0.04 respectively). Interestingly, there were no baseline differences between the study groups, and thus no statistical adjustment was done.…”

Comparison of Drug-Coated Balloon Angioplasty vs. Drug-Eluting Stent Implantation for Drug-Eluting Stent Restenosis in the Routine Clinical Practice: A Meta-Analysis of Randomized Controlled Trials

“…DES, especially new-generation (NG-DES)/EES, was superior to DCB in reducing the risk of TLR in this meta-analysis. But treatment with DCB for DES-ISR could avoid multilayers of metal stents in the coronary artery, which poses difficulty for further treatment of recurrent restenosis and is associated with a poor prognosis (23)(24)(25). In addition, DCB may be more suitable for patients who are intolerable of long-term DAPT or at a high risk of bleeding (26,27).…”

Effects of a Matrix Metalloproteinase Inhibitor-Eluting Stent on In-Stent Restenosis

“…The prevalence of restenosis after baremetal stent (BMS) placement is ~10% [4]. Use of drug-eluting stents (DESs) reduces the risk of restenosis and revascularization of the target lesion, but the absolute number of instances of ISR cannot be ignored [5]. ISR remains an important issue in arterial stenting.…”