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Drug-eluting balloons versus new generation drug-eluting stents for the management of in-stent restenosis: an updated meta-analysis of randomized studies. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2019; 16:448-457. [PMID: 31308837 PMCID: PMC6612611 DOI: 10.11909/j.issn.1671-5411.2019.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background New-generation drug-eluting stents (DES) was more effective in the treatment of in-stent restenosis (ISR) compared with the first-generation DES. Drug-eluting balloons (DEB) and new-generation DES had been available strategies in treatment of bare-metal stents/DES ISR (BMS/DES-ISR). Six new randomized trials have recently examined the angiographic outcomes and one-year clinical outcomes of DEB and new generation DES in BMS/DES-ISR. However, the optimal management for BMS/DES-ISR lesions remains controversial. Methods We searched the randomized clinical trials evaluating the angiographic outcomes and one-year clinical outcomes of DEB and new-generation DES in patients with BMS/DES-ISR. The primary endpoints were the angiographic outcomes, including the minimal luminal diameter (MLD), diameter stenosis % (DS%), late lumen loss (LLL), and binary restenosis (BR). Results A total of six randomized clinical trials with 1177 BMS/DES-ISR patients were included in our meta-analysis. For angiographic outcomes, there were significantly less MLD and more DS% with DEB compared to new-generation DES (MLD: MD = -0.18, 95% CI: -0.31- -0.04, P < 0.001; DS%: MD = 5.68, 95% CI: 1.00-10.37, P < 0.001). Moreover, for one-year clinical outcomes, DEB was associated with a significant increase risk in target lesion revascularization (TLR) (RR = 2.93, 95% CI: 1.50-5.72, P = 0.002). However, DEB was associated with higher risks of major adverse cardiac event, target vessel revascularization, TLR, BR, and more DS% only in DES-ISR group. Conclusions DEB and new-generation DES have the similar clinical efficacy for the treatment of BMS-ISR. However, DES showed more MLD, less DS%, and a decreased risk of TLR for the treatment of DES-ISR.
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Huang YH, Xu Q, Shen T, Li JK, Sheng JY, Shi HJ. Prevention of in-stent restenosis with endothelial progenitor cell (EPC) capture stent placement combined with regional EPC transplantation: An atherosclerotic rabbit model. Cardiol J 2018; 26:283-291. [PMID: 29611172 DOI: 10.5603/cj.a2018.0027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 12/14/2017] [Accepted: 01/15/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Even with drug-eluting stents, the risk of in-stent restenosis (ISR) remains high. The goal of this study was to investigate the use of an endothelial progenitor cell (EPC) capture stent plus regional EPC transplantation to reduce the ISR rate. METHODS Endothelial progenitor cell capture stents were fabricated using fibrin gel and anti-CD34 plus anti-VEGFR-2 dual antibodies. Twenty male New Zealand white rabbits established as an atherosclerotic model were randomly divided into two groups: group 1 (n = 10), in which EPC capture stents were deployed into the right iliac artery; and group 2 (n = 10), in which sirolimus-eluting stents were placed. In both groups, EPCs were transplanted into target vessels beyond the stents, with outflow blocked. Radiologic-pathologic correlation outcomes were reviewed after 2 months. RESULTS The technical success rate of EPC capture stent placement plus EPC transplantation was 100%. The ISR rate in group 1 was lower than in group 2 (1/10 vs. 4/10; p > 0.05). Minimal luminal diameters were larger in group 1 than in group 2 (computed tomographic angiography, 1.85 ± 0.15 mm vs. 1.50 ± 0.20 mm; duplex ultrasound, 1.90 ± 0.10 mm vs. 1.70 ± 0.30 mm; p > 0.05). Transplanted EPCs were tracked positively only in group 1. Pathologic analysis demonstrated neointimal hyperplasia thickness of 0.21 ± 0.09 mm in group 1 vs. 0.11 ± 0.07 mm in group 2 (p < 0.05). CONCLUSION Endothelial progenitor cell capture stent placement plus local EPC transplant decreases the ISR rate through thrombosis reduction rather than through neointimal hyperplasia inhibition.
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Affiliation(s)
- You-Hua Huang
- Department of Radiology, Wujin Hospital, Jiangsu University, Changzhou, China
| | - Qiang Xu
- Department of Radiology, Wujin Hospital, Jiangsu University, Changzhou, China
| | - Tao Shen
- Department of Radiology, Wujin Hospital, Jiangsu University, Changzhou, China
| | - Jian-Ke Li
- Department of Radiology, Wujin Hospital, Jiangsu University, Changzhou, China
| | - Jing-Yu Sheng
- Department of Cardiology, Wujin Hospital, Jiangsu University, Changzhou, China
| | - Hong-Jian Shi
- Department of Radiology, Wujin Hospital, Jiangsu University, Changzhou, China.
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Pleva L, Kukla P, Kusnierova P, Zapletalova J, Hlinomaz O. Comparison of the Efficacy of Paclitaxel-Eluting Balloon Catheters and Everolimus-Eluting Stents in the Treatment of Coronary In-Stent Restenosis: The Treatment of In-Stent Restenosis Study. Circ Cardiovasc Interv 2016; 9:e003316. [PMID: 27069104 DOI: 10.1161/circinterventions.115.003316] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 03/15/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND The aim of this prospective randomized noninferiority study was to compare the efficacy of paclitaxel-eluting balloon (PEB) catheters and everolimus-eluting stents (EES) in the treatment of bare metal stent restenosis. METHODS AND RESULTS A total of 136 patients were enrolled in the study. Each treatment group included 68 patients with 74 in-stent restenotic lesions. The primary end point was in-segment late lumen loss (LLL) at 12 months. Secondary end points were the incidence of binary in-stent restenosis and 12-month major adverse cardiac events. The 2-sided 95% confidence interval of LLL difference between treatments (0.149-0.558) was greater than noninferiority margin (0.12), which demonstrates both noninferiority and superiority of PEB treatment. Furthermore, the PEB group had significantly less 12-month LLL than the EES group (0.02 versus 0.19 mm; P=0.0004). The difference in the incidence of repeated binary restenosis (8.7% versus 19.12%; P=0.078) and 12-month major adverse cardiac events (10.29% versus 19.12%; P=0.213) was not significant. The 12-month LLL was significantly less in the PEB group and also in subgroups with in-stent restenosis >10 mm (0.05 versus 0.26 mm; P=0.0002) and artery diameter <3 mm (0.05 versus 0.16 mm; P=0.003) compared with the EES groups, but not in the subgroup of patients with diabetes mellitus (P=0.254). In the EES group, repetitive binary restenosis had a significantly greater chance of occurring (odds ratio=3.132; 95% confidence interval, 1.058-9.269; P=0.039), even when adjusting for other risk factors. CONCLUSIONS Treatment of bare metal stent restenosis using PEB led to significantly less 12-month LLL than the implantation of second-generation EES. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01735825.
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Affiliation(s)
- Leos Pleva
- From the Department of Cardiovascular Diseases (L.P., P.K.) and Department of Laboratory Medicine (P.K.), University Hospital Ostrava, Czech Republic; Department of Biomedical Sciences, Medical Faculty, University of Ostrava, Ostrava, Czech Republic (P.K.); Department of Medical Biophysics, Palacky University, Olomouc, Czech Republic (J.Z.); Department of Cardioangiology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic (O.H.); and International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic (O.H.).
| | - Pavel Kukla
- From the Department of Cardiovascular Diseases (L.P., P.K.) and Department of Laboratory Medicine (P.K.), University Hospital Ostrava, Czech Republic; Department of Biomedical Sciences, Medical Faculty, University of Ostrava, Ostrava, Czech Republic (P.K.); Department of Medical Biophysics, Palacky University, Olomouc, Czech Republic (J.Z.); Department of Cardioangiology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic (O.H.); and International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic (O.H.)
| | - Pavlina Kusnierova
- From the Department of Cardiovascular Diseases (L.P., P.K.) and Department of Laboratory Medicine (P.K.), University Hospital Ostrava, Czech Republic; Department of Biomedical Sciences, Medical Faculty, University of Ostrava, Ostrava, Czech Republic (P.K.); Department of Medical Biophysics, Palacky University, Olomouc, Czech Republic (J.Z.); Department of Cardioangiology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic (O.H.); and International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic (O.H.)
| | - Jana Zapletalova
- From the Department of Cardiovascular Diseases (L.P., P.K.) and Department of Laboratory Medicine (P.K.), University Hospital Ostrava, Czech Republic; Department of Biomedical Sciences, Medical Faculty, University of Ostrava, Ostrava, Czech Republic (P.K.); Department of Medical Biophysics, Palacky University, Olomouc, Czech Republic (J.Z.); Department of Cardioangiology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic (O.H.); and International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic (O.H.)
| | - Ota Hlinomaz
- From the Department of Cardiovascular Diseases (L.P., P.K.) and Department of Laboratory Medicine (P.K.), University Hospital Ostrava, Czech Republic; Department of Biomedical Sciences, Medical Faculty, University of Ostrava, Ostrava, Czech Republic (P.K.); Department of Medical Biophysics, Palacky University, Olomouc, Czech Republic (J.Z.); Department of Cardioangiology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic (O.H.); and International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic (O.H.)
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