Outcomes Of Drug-coated Balloon For Treating The Side-branch Of Coronary Bifurcation Lesions:A Meta-analysis Of Randomized Controlled Trials

Background:The Provisional technique proposed by the European club is commonly used in coronary bifurcation disease,however,there are sitll many shortcomings in both single-stent technique and double-stent technique.In terms of double-stent strategy,low PCI success rate,more complications,increased perioperative myocardial infarction,stent deformation or even damaged,the artificial boundary ridge whether endothelial,stent whether fully expanded or stick wall,final kissing whether be completed,endothelial chronic inflammation caused by the proximal multiplayer,operation time prolonged,more contrast medium exposure and other issues still bothering many PCI performer.For the single stent strategy,residual stenosis of side branch opening,side branch restenosis,elastic retraction of vessels,and acute occlusion of side branch caused by “shoveling effect”are not uncommon.In recent years,the efficacy of drug-coated balloons in coronary artery disease has been recognized,especially in stent restenosis.The paclitaxel coated balloon with paclitaxel on its sueface,which is fat-soluble and easy to bind through the cell membrane and microtubules to produce anti-cell division and anti-proliferation effects,thereby reducing the occlusion rate of blood vessels and the long-term internal diameter loss rate of blood vessels,and improving the success rate and safety of the intervetion.Objective:Nowdays,researchs about the value of DCB for treating coronary bifurcations are very few,still,the merits remain controversial.Herein,we conducted a meta-analysis to value the efficacy and safety of DCB for treatment of coronary bifurcations,and provide guidance for clinical treatment.Methods:We searched Cochrane Library,Pubmed,EMBACE,Wanfang,CNKI,CBM,VIP for eligible trials about DCB for treatment of coronary bifurcations.We alsoconsidered published review articles,editorials,and internet-based sourses of information to assess potential information on trials of interest.The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses(PRISMA)guidelines for mate-analyses of randomized trials.The primary endpoint was late lemen loss(LLL).The secondary endpoints was major adverse cardiovascular events,target-lesion revascularization(TLR)and restenosis rates of the side branch.Results:Four trials with a total of 309 patients were included.There were no significant differences in MACE between the DEB and CB groups(Risk Ratio(RR)0.92;95%conffidence interval(CI)(0.47,1.79);P=0.81),or in TLR(Risk Ratio(RR)1.10;95%conffidence interval(CI)(0.33,3.60);P=0.88),or in restenosis rates of the side branch(Risk Ratio(RR)0.48;95%conffidence interval(CI)(0.15,1.54);P=0.22).However,the LLL in DCB group was lower than that in CB group with no significance(Risk Ratio(RR)-0.15;95%conffidence interval(CI)(-0.31,-0.02);P=0.08).The same as MACE rate,TLR,MI,death rate in DEB.Conclusion:Although DCB is no significantly statistical differences in LLL?MACE?TLR?side branch restenosis,it tend to with a lower LLL and MACE.Think of only 4 study been included,the sample is small,so there is still further research value.