Meta-analysis of Usefulness of Drug Coated Balloon Versus Standard Balloon in the Treatment of Femoropopliteal In-Stent-Restenosis

Doshi, Rajkumar; Kumar, Ashish; Adalja, Devina; Vaz, Igor; Shariff, Mariam

doi:10.1016/j.amjcard.2020.07.024

Cited by 5 publications

(7 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…DCB shows superior results compared to traditional re-PTA with a stent and is becoming the technique of choice for ISRs [ 12 , 13 , 14 , 15 , 62 ]. Combined techniques such as laser atherectomy and DCB are also being developed and appear to be candidates to become the reference technique, but adequate studies are warranted [ 1 , 11 , 18 , 19 ]. In all the studies included in this review, the treatment with DCB demonstrated a higher rate of patency and minor rate of restenosis during the follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…In the past, there was also stent fracturing, which is particularly common with older self-expanding stents [ 10 ]. Many techniques have been proposed for the resolution of ISR such as intravascular brachytherapy, laser atherectomy, second stenting and drug-coated balloon (DCB) [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…Balloon dilatation and stent implantation is associated with vascular injury, followed by repair processes that include endothelialization and neointimal formation, providing for the activation of the inflammatory response and the release of blood inflammatory markers [ 9 , 10 , 11 ]. The analysis of these biomarkers could prove useful to physicians to predict an eventual predisposition to ISR.…”

Section: Introductionmentioning

confidence: 99%

“…DCB has been shown to yield excellent results in the setting of PAD. Angiographic and clinical data highlight the superiority of this technique, and the European clinical practice guidelines endorsed its use in the treatment of ISR (class I, Evidence A) [ 11 , 12 , 13 ]. The DCB is a traditional drug-coated balloon, mainly with Paclitaxel, which significantly improves the short- and medium-term patency of angioplasty by minimizing neo-intimal hyperplasia [ 14 , 15 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The Diagnostic Value of Circulating Biomarkers and Role of Drug-Coated Balloons for In-Stent Restenosis in Patients with Peripheral Arterial Disease

et al. 2022

View full text Add to dashboard Cite

Peripheral arterial disease (PAD) is an increasingly pathological condition that commonly affects the femoropopliteal arteries. The current fashionable treatment is percutaneous transluminal angioplasty (PTA), often with stenting. However, the in-stent restenosis (ISR) rate after the stenting of the femoropopliteal (FP) district remains high. Many techniques have been proposed for the treatment of femoropopliteal ISR, such as intravascular brachytherapy, laser atherectomy, second stenting and drug-coated balloons angioplasty (DCB). DCB showed a significantly lower rate of restenosis and target lesions revascularization (TLR) compared to conventional PTA. However, further studies and multi-center RCTs with dedicated long-term follow-up are needed to verify the true efficiency of this approach. Nowadays, the correlation between PAD and inflammation biomarkers is well known. Multiple studies have shown that proinflammatory markers (such as C-reactive proteins) and the high plasma levels of microRNA could predict the outcomes after stent placement. In particular, circulating microRNA-320a, microRNA-3937, microRNA-642a-3p and microRNA-572 appear to hold promise in diagnosing ISR in patients with PAD, but also as predictors of stent patency. This narrative review intends to summarize the current knowledge on the value of circulating biomarkers as predictors of ISR and to foster the scientific debate on the advantages of using DCB in the treatment of ISR in the FP district.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Diagnostic Value of Circulating Biomarkers and Role of Drug-Coated Balloons for In-Stent Restenosis in Patients with Peripheral Arterial Disease

et al. 2022

View full text Add to dashboard Cite

show abstract

“…The results indicated no difference in all-cause mortality or TLR risk for DCB compared to SBA at the 12-month follow-up. 45 However, several meta-analyses and studies have demonstrated the superiority of DCB compared to SBA in treating ISR in the femoropopliteal artery. Inhibition of cell proliferation by local administration reduces the recurrence of restenosis.…”

Section: Discussionmentioning

confidence: 99%

The safety and efficacy of different endovascular treatments for in-stent restenosis of the femoropopliteal artery: A network meta-analysis

Wang

Lin

et al. 2022

Vasc Med

View full text Add to dashboard Cite

Purpose: Femoropopliteal artery in-stent restenosis (ISR) remains a challenging treatment. We performed a network meta-analysis (NWM) for femoropopliteal artery ISR to explore the safety and efficacy of endovascular therapeutic strategies. Methods: The MEDLINE, Embase, Web of Science, and Cochrane databases were used as data sources. The network meta-analysis (NWM) approach used random-effects models based on the frequentist framework. We compared technical success rate, primary patency, target lesion revascularization (TLR), and major amputation at the 12-month follow-up for femoropopliteal artery ISR. Results: In total, 14 eligible studies (10 prospective and four retrospective; 1348 patients; and eight treatment modalities – standard balloon angioplasty (SBA), drug-coated balloon (DCB), peripheral cutting balloon angioplasty (PCBA), Viabahn endoprosthesis (VBE), directional atherectomy (DA), excimer laser atherectomy (ELA), and combinations – were included. The primary patency rates (at 6 months) were significantly higher for DCB and ELA+DCB than for SBA and ELA+SBA. ELA+DCB had higher primary patency rates (at 12 months) than ELA+SBA and SBA. The technical success rates were significantly lower for DCB and SBA than for VBE. The major amputation rates were significantly lower for ELA+DCB than for DCB. Based on the surface values under the cumulative ranking curve (SUCRA), ELA+DCB was considered the best treatment in terms of primary patency at 6 months (SUCRA = 91.1), primary patency at 12 months (SUCRA = 82.3), and TLR (SUCRA = 83.4). Conclusion: ELA+DCB showed positive encouraging results in primary patency (6, 12 months), TLR, and major amputation in femoropopliteal ISR. The efficacy and safety of ELA+DCB are worthy of further investigation. (PROSPERO Registration No.: CRD42021246674)

show abstract

Network Meta-Analysis of All Available Regimens Based on Drug-Coated Balloon Angioplasty and Laser Atherectomy for Femoropopliteal In-Stent Restenosis

Tang

Ren

et al. 2022

J Endovasc Ther

View full text Add to dashboard Cite

Purpose: Drug-coated balloon (DCB) angioplasty and laser atherectomy (LA) have been frequently utilized to treat femoropopliteal in-stent restenosis (ISR); however, no studies have concurrently compared available regimens, including DCB, LA+DCB, and LA + plain balloon angioplasty (PB). Therefore, we conducted this network meta-analysis to determine whether there were significant differences in outcomes among these regimens. Materials and Methods: A comprehensive search was conducted in PubMed, EMBASE, and the Cochrane library to identify all randomized controlled trials comparing DCB or LA-based regimes with POBA or each other for treating femoropopliteal in-stent restenosis (ISR) from their inception until March 2021. The primary outcome measure was binary restenosis, and secondary outcome measures were target lesion revascularization (TLR) and mortality, evaluated at 6 and 12 months, respectively. Statistical analysis was performed using Aggregate Data Drug Information System (ADDIS) 1.4 software, and all data were graphically summarized using Microsoft Excel software. Results: The final analysis included 11 studies, of which 6 studies compared DCB with PB, 2 studies compared PB vs LA+PB, 2 studies compared DCB vs LA+DCB, and 1 study compared LA+DCB with LA+PB. DCB was better than PB in decreasing binary restenosis at 6 (odds ratio [OR]: 0.22, 95% credible interval [CrI]: 0.04–0.91) and 12 (OR: 0.26, 95% CrI: 0.12–0.50) months. DCB was associated with lower TLR than PB at 6 months (OR: 0.31, 95% CrI: 0.13–0.69). LA+DCB was also superior to PB in treating binary restenosis at 12 months (OR: 6.10, 95% CrI: 1.94–24.41) and TLR at 6 months (OR: 5.32, 95% CrI: 1.43–28.06). There was no statistical difference in mortality between PB, DCB, and LA+PB. DCB and LA+DCB were the first 2 options for reducing binary restenosis and TLR. Conclusion: The current network meta-analysis demonstrates that both DCB and LA+DCB are superior to PB alone, and that DCB and LA+DCB may be the preferred treatment options for reducing binary restenosis and TLR. Clinical Impact The treatment for femoropopliteal in-stent restenosis (ISR) remains challenging clinical practice. One important reason is that no optimal treatment strategy was available. Drug-coated balloon angioplasty (DCB) and laser atherectomy (LA) have been extensively utilized to treat ISR; however, different combinations of these treatments further confused the clinicians’ choices. This network meta-analysis systematically investigated the difference between the currently available treatments regarding therapeutic effects and safety, indicating that DCB and LA+DCB may be the optimal treatment for decreasing the risk of binary restenosis and target lesion revascularization. The results of the current network meta-analysis help to resolve the confusion of clinicians in making the decision.

show abstract

Meta-analysis of Usefulness of Drug Coated Balloon Versus Standard Balloon in the Treatment of Femoropopliteal In-Stent-Restenosis

Cited by 5 publications

References 5 publications

The Diagnostic Value of Circulating Biomarkers and Role of Drug-Coated Balloons for In-Stent Restenosis in Patients with Peripheral Arterial Disease

The Diagnostic Value of Circulating Biomarkers and Role of Drug-Coated Balloons for In-Stent Restenosis in Patients with Peripheral Arterial Disease

The safety and efficacy of different endovascular treatments for in-stent restenosis of the femoropopliteal artery: A network meta-analysis

Network Meta-Analysis of All Available Regimens Based on Drug-Coated Balloon Angioplasty and Laser Atherectomy for Femoropopliteal In-Stent Restenosis

Contact Info

Product

Resources

About