New-generation drug-eluting stents (DES) appear to be associated with improved angiographic and clinical outcomes when compared to drug-coated balloon (DCB) in patients with coronary in-stent restenosis.
A meta-analysis of five randomised controlled trials found patients treated with new-generation DES had a significant increase of acute luminal gain and a reduction of per cent diameter stenosis at 6-12 months follow-up.
DES was also associated with comparable rates of major adverse cardiac events to DCB (9.0 v 14.7%) and a reduced rate of target lesion revascularisation (5.2 v 10.9%).
“The difference of TLR was possibly related to the fact that presence of an existing additional stent layer in the DES group discouraged the operator from repeat intervention,” the researchers said in BMJ Open.
“Although one may argue that DES add one more stent layer in the finite lesion segment, 80–100 μm of lumen loss due to the implants seems negligible when considering that new-generation DES assumes less reintervention.”
Cardiac death, all-cause death, myocardial infarction and stent thrombosis were not significantly different based on the type of intervention.
“The advantages of new-generation DES comprised of persistent radial strength which prevents acute or subacute prolapse of the disrupted plaque and elastic recoil of the vessel wall, sufficient antiproliferative drugs and subsequent excellent neointimal hyperplasia inhibition compared with DCB.”
However they acknowledged there were concerns about multilayers of stenting in the vessel wall and the implications for future treatment and longer-term prognosis.
They said bioresorbable scaffolds might be an alternative treatment option in the future.
In-stent restenosis was a significant problem in clinical practice, affecting nearly 5% of patients treated with DES and 10% with BMS after five years, the study authors noted.
“Given the number of patients undergoing a stent implantation, which amounts to approximately 1 000 000 per annum in the USA, in-stent restenosis will continue to remain an undesirable adverse outcome,” they observed.