Second‐generation drug‐eluting stents versus drug‐coated balloons for the treatment of coronary in‐stent restenosis: A systematic review and meta‐analysis

Kokkinidis, Damianos G.; Prouse, Andrew; Avner, Seth; Lee, Joo Myung; Waldo, Stephen W.; Armstrong, Ehrin J.

doi:10.1002/ccd.27359

Cited by 10 publications

(7 citation statements)

References 55 publications

(111 reference statements)

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“…This observation was corroborated by Siontis et al (27 trials, 5923 patients) and Kokkinidis et al (10 studies, 2173 patients), which demonstrated that the use of second generation DES was the most effective strategy. 15,16 In summary, current clinical data support the use of DCB in BMS/DES ISR as an alternative to receiving a DES stent.…”

Section: Clinical Use Of Dcb In Coronary Artery Disease (Cad)mentioning

confidence: 91%

Drug-coated balloons: Technical and clinical progress

et al. 2020

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The advancement of drug-coated balloons (DCB) presents an alternative nonstent method in the percutaneous treatment of atherosclerotic lesions. While the current generation of drug-eluting stents (DES) are the device of choice, especially in coronary artery disease (CAD), DCB has potential applications in the treatment of de novo lesions, in-stent restenosis (ISR), bifurcations, and in peripheral artery disease (PAD). In terms of coronary clinical experience, DCB is used most in ISR scenarios and more data are collected to support the use of DCB in de novo lesions compared to best-in-class DES. The use of DCB in bifurcation side branch treatment has demonstrated safety, and with good angiographic and clinical outcomes, but more data from randomized trials will be required to assess its clinical value. For PAD, the clinical outcomes of DCB with and without debulking devices in diseased femoropopliteal arteries and treatment of below-the-knee (BTK) vessels with DCB are discussed. Current data demonstrated conflicting long-term safety outcomes in the use of paclitaxel devices in the femoral and/or popliteal arteries, while the role of DCB in BTK disease remains uncertain due to a lack of randomized controlled trial data. In summary, this review provides an overall view of current DCB technologies and progress, followed by an update on DCB clinical data in the treatment of CAD and PAD.

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Section: Clinical Use Of Dcb In Coronary Artery Disease (Cad)mentioning

confidence: 91%

Drug-coated balloons: Technical and clinical progress

et al. 2020

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“…The treatment options for ISR include PCI with DESs, DCBs, or PTCA. DCBs and second-generation DESs were equally effective in treating coronary ISR, according to a new systematic review and meta-analysis [ 20 ]. Paclitaxel and rapamycin analogues have been proven successful in preventing neointimal hyperplasia and ISR.…”

Section: Evidence-based Practice Of Treating Isr Using Dcbsmentioning

confidence: 99%

In-Stent Restenosis and a Drug-Coated Balloon: Insights from a Clinical Therapeutic Strategy on Coronary Artery Diseases

Zhang

Chen

2020

Cardiology Research and Practice

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Coronary heart disease is a major cause of death and disability in developed countries. Stent implantation has become an efficacious treatment for a culprit lesion vessel of the coronary artery. However, 10%–20% restenosis is still an important complication that restricts the clinical safety and efficacy of drug-eluting stents. In-stent restenosis may lead to the recurrence of major cardiovascular adverse events, including angina pectoris, acute myocardial infarction, and even sudden cardiac death. These events are currently serious problems that occur after coronary stent implantation. Clinical physicians face a difficult choice for in-stent restenosis treatment. Recent studies indicate that a drug-coated balloon has promising clinical efficacy similar to the drug-eluting stents for treating coronary in-stent restenosis. Therefore, in this study, we highlight the progress of coronary intervention and the use of drug-coated balloons in the treatment of in-stent restenosis (ISR).

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“…Drug-coated balloon (DCB) angioplasty is an effective strategy for the treatment of patients with coronary ISR and showed comparable results with second-generation DES. 6,7 However, recurrent ISR after DCB angioplasty for DES ISR was also problematic with a high incidence of recurrent ISR after DCB. 8 We hypothesized that measurement of OCT-derived parameters during the procedure can predict future adverse events after DCB angioplasty for DES ISR.…”

Section: Introductionmentioning

confidence: 99%

“…Drug‐coated balloon (DCB) angioplasty is an effective strategy for the treatment of patients with coronary ISR and showed comparable results with second‐generation DES 6,7 . However, recurrent ISR after DCB angioplasty for DES ISR was also problematic with a high incidence of recurrent ISR after DCB 8 .…”

Section: Introductionmentioning

confidence: 99%

Clinical implication of neointimal burden in in‐stent restenosis treated with drug‐coated balloon

Lee

Kim

et al. 2020

Cathet Cardio Intervent

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Background: Although drug-coated balloon (DCB) angioplasty is a well-established drug-eluting stent (DES) in-stent restenosis (ISR) strategy, there are minimal data regarding the association of neointimal burden on optical coherence tomography (OCT) before and after DCB and adverse clinical events. This study aimed to investigate the clinical impact of neointimal burden measured with OCT in patients with DES ISR after DCB angioplasty.Methods: From 2010 through 2013, a total of 122 patients with 122 ISR lesions were treated with DCB, which was preceded and followed by OCT examination.Major adverse cardiac events (MACE, a composite occurrence of cardiovascular cardiac death, nonfatal myocardial infarction [MI], or target lesion revascularization [TLR]) were evaluated.Results: MACE occurred in 27 patients (4 nonfatal MIs and 23 TLRs) during the follow-up (median: 55.3 months, interquartile range 43.1-66.0). The mean lumen area was significantly smaller (3.21 ± 2.42 mm 2 vs. 4.80 ± 2.53 mm 2 , p = .005) and the mean percentage of neointimal volume derived by OCT was greater (49.3 ± 9.2% vs. 38.3 ± 17.5%, p = .006) in patients with MACE before DCB angioplasty. The preprocedural mean percentage of neointimal volume (cut-off 50%, area under the receiver operating characteristic [ROC] curve = 0.644, 95% confidence interval [CI] = 0.531-0.758, p = .022) and post-procedural mean percentage of neointimal volume (cut-off 25%, area under ROC curve = 0.659, 95% CI = 0.546-0.773, p = .012) were identified as significant parameters to predict MACE. Conclusion:The OCT-derived mean percentages of neointimal volume before and after DCB angioplasty can be important parameters for predicting future MACE in patients with DES ISR.

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Second‐generation drug‐eluting stents versus drug‐coated balloons for the treatment of coronary in‐stent restenosis: A systematic review and meta‐analysis

Abstract: The two treatment strategies are equal for the treatment of ISR, while the difference in all-cause mortality might be potentially explained by baseline differences in the two groups among real-world studies.

Cited by 10 publications

References 55 publications

Drug-coated balloons: Technical and clinical progress

Drug-coated balloons: Technical and clinical progress

In-Stent Restenosis and a Drug-Coated Balloon: Insights from a Clinical Therapeutic Strategy on Coronary Artery Diseases

Clinical implication of neointimal burden in in‐stent restenosis treated with drug‐coated balloon

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