OR05-4
Comparison Among Different Treatment Strategies for Treatment of DES In-Stent Restenosis: A Network Meta- Analysis
Presenter
Dhan Shrestha, Mount Sinai Hospital , Chicago, IL
Dhan Shrestha1, Prakash Raj Oli, MBBS2, Sagun Dawadi, MBBS3, Shraddha Poudel, MD4, Furkhan Ali, MS2, Jurgen Shtembari1, Kailash Pant, MD5, Bishesh Shrestha, MD6, Daniel Katz, MD7, Rafay Khan, MD8 and Jishanth Mattumpuram, MD8, (1)Mount Sinai Hospital , Chicago, IL, (2)Mount Sinai Hospital, Chicago, IL, (3)Nepalese Army Institute of Health Sciences, Kathmandu, 3, Nepal, (4)Medstar Union Memorial Hospital, Baltimore, MD, (5)University of Illinois College of Medicine at Peoria, Peoria, IL, (6)Bassett Medical Center, Omaha, NE, (7)Bassett Medical Center, Cooperstown, NY, (8)University of Louisville School of Medicine, Louisville, KY
Keywords: Coronary, Drug-coated Balloon (DCB), Drug-eluting Stent (DES), Intravascular Lithotripsy (IVL) and Stable Ischemic Heart Disease (SIHD)
Background
Bare-metal stents (BMS) has a higher risk of in-stent restenosis (ISR), which is relatively low with drug-eluting stents (DES). Various interventions for ISR include balloon angioplasty (BA), drug-coated balloons (DCB), DES implantation, ECLA, coronary IVL, etc. Given that the evidence regarding therapeutic interventions is elusive, we planned to pool and compare available data for DES-ISR in this network meta-analysis.
Methods
We did a Bayesian network meta-analysis to synthesize evidence from relevant studies. We searched literatures published up to December 30, 2023, of treatment strategies for treating DES-ISR. This study is registered with PROSPERO, and data analysis was performed using the netmeta package version 2.8-2 on the R 4.3.2 version.
Results
Out of 1202 studies, 31 were deemed eligible, with 11 being randomized controlled trials and 20 observational studies, including 9746 patients with DES ISR. In our network meta-analysis for DES-ISR, no significant differences observed between the procedures employed regarding MACE events and TLR in 6-12 months follow-up, except for Percutaneous Old Balloon Angioplasty (POBA). DCB and EES were superior to POBA for both MACE and TLR.
Conclusions
DCB and EES were superior to POBA for MACE and TLR. No significant differences were observed between other procedures employed regarding MACE events and TLR in individuals with DES-ISR. However, this data is limited by scarce studies in many procedures evaluated in the studies. In the future, larger controlled trials may shed light on the superiority of one over another.
