PT  - JOURNAL ARTICLE
AU  - Indermuehle, Andreas
AU  - Bahl, Rahul
AU  - Lansky, Alexandra J
AU  - Froehlich, Georg M
AU  - Knapp, Guido
AU  - Timmis, Adam
AU  - Meier, Pascal
TI  - Drug-eluting balloon angioplasty for in-stent restenosis: a systematic review and meta-analysis of randomised controlled trials
AID  - 10.1136/heartjnl-2012-302945
DP  - 2013 Mar 01
TA  - Heart
PG  - 327--333
VI  - 99
IP  - 5
4099  - http://heart.bmj.com/content/99/5/327.short
4100  - http://heart.bmj.com/content/99/5/327.full
SO  - Heart2013 Mar 01; 99
AB  - Context The optimal treatment option for in-stent restenosis is currently unclear. Objective Systematic review and meta-analysis of the effect of drug-eluting balloons (DEB) to treat in-stent restenosis. Data sources Trials were identified through a literature search from 2005 through 7 November 2012. Study selection Randomised clinical trials comparing DEB with a control treatment (plain balloon angioplasty or drug-eluting stents). Data extraction and synthesis Main endpoints of interest were major adverse cardiac events (MACE), target lesion revascularisation (TLR), binary in-segment restenosis, stent thrombosis (ST), myocardial infarction (MI) and mortality. A random-effects model was used to calculate the pooled relative risks (RR) with 95% CIs. Results Five studies and a total of 801 patients were included in this analysis. Follow-up duration ranged from 12 to 60months. Most endpoints were significantly reduced for DEB compared with the control groups. For MACE, the relative risk RR was 0.46 (0.31 to 0.70), p<0.001, for TLR it was 0.34 (0.16 to 0.73); p=0.006, for angiographic in-segment restenosis it was 0.28 (0.14 to 0.58); p<0.001. There was a lower mortality for DEB (RR 0.48 (0.24 to 0.95); p=0.034). The incidence of MI was numerically lower, but the differences were not statistically significant (RR 0.68 (0.32 to 1.48); p=0.337). There was no difference in the risk of ST (RR 1.12 (0.23 to 5.50), p=0.891). Conclusions In-stent restenosis is the bane of coronary angioplasty, and drug-eluting balloon angioplasty is a promising treatment option in this situation. It reduces the risk for MACE compared with plain balloon angioplasty or implantation of a Taxus Liberte drug-eluting stent.