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Updated: Jul 5, 2026
Imaging In-Stent Restenosis: An Inexpensive, Reliable, and Rapid Preclinical Model
Published on: September 14, 2009
Drug-Coated Balloons versus Everolimus-Eluting Stents in Patients with In-Stent Restenosis: A Pair-Wise Meta-Analysis
Nina Peng1, Wei Liu2, Zongzhuang Li2
1Department of Internal Medicine, Guizhou Orthopedics Hospital, Guiyang, China.
Insights
Drug-coated balloons (DCB) show inferior outcomes compared to everolimus-eluting stents (EES) for drug-eluting stent in-stent restenosis (DES-ISR). However, DCB and EES demonstrate comparable results for bare metal stent in-stent restenosis (BMS-ISR).
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Medical Device Technology
Background:
- In-stent restenosis (ISR) remains a challenge in coronary interventions.
- Assessing the comparative efficacy and safety of drug-coated balloons (DCB) versus everolimus-eluting stents (EES) for ISR treatment is crucial.
- Understanding differential outcomes based on stent type (DES-ISR vs. BMS-ISR) is essential for clinical decision-making.
Purpose of the Study:
- To compare the effectiveness of DCB versus EES in treating ISR.
- To evaluate the differential impact of DCB in patients with DES-ISR and BMS-ISR.
Main Methods:
- Systematic literature search of PubMed and EMBASE.
- Inclusion of six randomized trials involving 1134 patients.
- Subgroup meta-analyses stratified by restenosed stent type (DES-ISR and BMS-ISR).
Main Results:
- Overall, DCB was associated with lower minimum lumen diameter and higher target lesion revascularization compared to EES.
- In DES-ISR patients, DCB showed inferior angiographic and clinical outcomes versus EES.
- No significant differences in outcomes were observed between DCB and EES in BMS-ISR patients.
Conclusions:
- DCB is less effective than EES for treating DES-ISR.
- DCB offers comparable efficacy to EES for BMS-ISR.
- Treatment choice between DCB and EES for ISR should consider the type of previously implanted stent.
Objective:
This study aimed to compare the effectiveness of drug-coated balloons (DCB) with everolimus-eluting stents (EES) in the treatment of in-stent restenosis (ISR) and the differential relative effect of DCB in patients with drug-eluting stents (DES)-ISR and bare metal stents (BMS)-ISR.
Background:
The efficiency and safety of DCB and EES need to be assessed for the treatment of ISR.
Methods:
A systematic literature search was conducted using PubMed and EMBASE to identify all relevant studies. Angiographic results and clinical events were separately assessed. Subgroup meta-analyses were performed according to the type of restenosed stent.
Results:
Six randomized trials with 1134 patients were included. The overall pooled outcomes indicated that DCB was associated with lower minimum lumen diameter (mean difference (MD) = -0.17, 95% CI = -0.29 to -0.05, P = 0.006) and higher target lesion revascularization (risk ratio (RR) = 2.38, 95% CI = 1.36 to 4.18, P = 0.002) than EES. However, the subgroup meta-analyses showed that DCB was inferior to EES only in DES-ISR patients, with lower minimum lumen diameter (MD = -0.25, 95% CI = -0.37 to -0.14, P < 0.001), higher percent diameter stenosis (MD = 5.37, 95% CI = 1.33 to 9.42, P = 0.009), more binary restenosis (RR = 2.07, 95% CI = 1.20 to 3.58, P = 0.009), and higher incidence of target vessel revascularization (RR = 2.07, 95% CI = 1.22 to 3.50, P = 0.007) and target lesion revascularization (RR = 2.43, 95% CI = 1.28 to 4.22, P = 0.002). No differences in angiographic results and clinical events were found between DCB and EES in BMS-ISR patients.
Conclusions:
DCB was inferior to EES in DES-ISR and comparable in BMS-ISR in terms of angiographic results and clinical events.
