Comparison of Different PCI Strategies for Coronary DES In-stent Restenosis: A Bayesian Network Meta-analysis
Author Department
Cardiology; Medicine
Document Type
Article, Peer-reviewed
Publication Date
1-2025
Abstract
Background: Though superior to bare-metal stents (BMS), drug-eluting stents (DES) based PCI still have significant in-stent restenosis (ISR). Balloon angioplasty (BA), drug-coated balloons (DCBs), and DES are common modalities to treat ISR. The existing guidelines recommend treating ISR with either DCB or DES for BMS-ISR and DES-ISR, despite differences in the underlying mechanisms. Because DES are currently the most used stents worldwide, we performed a network meta-analysis (NMA) to compare DES-ISR treatment strategies.
Methods: We searched Cochrane Central Register of Controlled Trials, PubMed, Embase, and Scopus for relevant studies published until March 30, 2024 and performed a Bayesian NMA to synthesize direct and indirect evidence. The primary outcome was a target lesion revascularization (TLR) at follow-up.
Results: Of 1202 studies, 30 were deemed eligible, with 15 being randomized studies. This included 8016 patients with DES-ISR who were assigned to 12 different PCI strategies. In the NMA for DES-ISR, paclitaxel-eluting stent (76.42) was the most effective strategy for TLR; paclitaxel-coated balloon (PCB) and scoring balloon angioplasty (75.88) for major adverse cardiovascular events (MACE); sirolimus-coated balloon (SCB) for target lesion failure (64.16), myocardial infarction (93.57), and stent thrombosis (98.53); and PCB for all-cause death (76.39) and cardiac death (83.74) based on SUCRA value. BA-based strategies were less effective alternatives for DES-ISR treatment with DCB or DES.
Conclusions: DES and DCB PCI such as PCB and SCB should be considered for treatment of coronary DES-ISR to achieve the most clinical efficacy and safety benefits for MACE. Further studies are required for more robust evidence on different treatment strategies.
Keywords: drug-coated balloon; drug-eluting stents; in-stent restenosis.
Recommended Citation
Oli PR, Shrestha DB, Dawadi S, Poudel S, Ali F, Shtembari J, Pant K, Shrestha B, Khan R, Mattumpuram J, Katz DH. Comparison of Different PCI Strategies for Coronary DES In-stent Restenosis: A Bayesian Network Meta-analysis. J Soc Cardiovasc Angiogr Interv. 2025 Jan 31;4(3Part A):102428. doi: 10.1016/j.jscai.2024.102428.
PMID
40231050