Drug-eluting Balloon Versus Second Generation Drug Eluting Stents In The Treatment Of In-stent Restenosis: Meta-analysis

Background: In-stent restenosis(ISR)remains a major complication following PCI.a number of clinical registriesand observational studies that implantation first-generation DES unselected patients reported restenosis rates 8-15%.The secondary--generation DES are characterized by improvements in thin-strut cobalt chromium,biodegradable polymer,more effective antiproliferative drug,compared with first-generation DES,the restenosis rates is lower.DEB are noninferior first-generation DES in the treatment of bare-metal stent –ISR.However,the relative efficacy of second-generation DES versus DEB in patients with DES-ISR remains unsettled.Aims:To estimate the efficacy of the treatment of drug eluting stent in-stent restenosis(DES-ISR)with drug eluting balloon(DEB)comparison to second generation drug eluting stent(DES).Methods: we performed the meta-analysis by searching CNKI?PubMed?Elsevier?EBSCO?MEDLINE?VIP?WANFANG database,retrieved all relevant article which compared the efficacy of DEB in the treatment of DES-ISR against second generation drug eluting stents(DES).Then,abstracted data which fit inclusive criteria,analysed data by RevMan version 5.2.Results: six studies comprised of 1196 patients with 1299 lesions were included for analysis.602 patients received a drug eluting balloon(DEB)and the rest received a second generation drug eluting stent(DES)for the treatment of drug eluting stent in-stent restenosis(DES-ISR).The follow-up period ranged from 6-48 months.Comparison with DEB,The use of DES was associated with an inferior acute gain in minimal luminal diameter(MLD)(0.58 mm,95%CI:0.26-0.91 mm,p=0.0004).there was no singnificant difference in the incidence of target lesion revascularization(14.3% vs 11.3%;RR:1.28,P=0.47)?target vessel revascularisation(13.2% vs 11.4%;RR:1.26;P=0.41)?major adverse cardiovascular event(14.8% vs 11.1%;RR:1.28;p=0.31)? myocardial infarction(2.0% vs 1.0%;RR:1.76;p=0.25)? Stent thrombus(0.8% vs 0.7%;RR:1.26;p=0.69)or all-cause mortality rate(2.0% vs 1.0%;RR:1.76;p=0.25)between the two groups.when performing sensitivity analysis,there was a strong trend towards higher target lesion revascularization(15.5% VS 10.4%;RR:1.57;p=0.07)and a significantly higher target vessel revascularisation(13.8% vs 10.5%;RR:1.52;p=0.02)?major adverse cardiovascular event(15.3% vs 9.9%;RR:1.5;p=0.01)rate in the DEB cohort.when subgroup analysis,there was no singnificant difference in the incidence of the incidence of clinical events follow-up 1 year or follow-up 2 years.Nevertheless,there was a significantly higher target lesion revascularization(13.6% VS 8.4%;RR:1.92;p=0.04)? target vessel revascularisation(16.2% vs 10.7%;RR:1.60;p=0.02)?major adverse cardiovascular event(14.9% vs 7.7%;RR:1.82;p=0.007)rate in the DEB cohort up to 1 year.Conclusion: Treatment of drug eluting stent restenosis using DEB was a alternative treatment option to second generation DES.Our META analysis inform that we must extend surveillance period after DES implanted.