title: A meta-analysis of randomised controlled trials assessing drug-eluting stents and vascular brachytherapy in the treatment of coronary artery in-stent restenosis.
abstract: OBJECTIVE
  We undertook a meta-analysis of randomised trials assessing the outcome of vascular brachytherapy (VBT) or DES for the treatment of coronary artery ISR.
  
  
  RESULTS
  Studies utilising DES or VBT for ISR were identified by a systematic search. Data was pooled and combined overall effect measures were calculated for a random effect model in terms of deaths, myocardial infarctions, revascularisation, binary restenosis, mean late luminal loss and major adverse cardiac events (MACE). Fourteen eligible studies (3103 patients) were included. Neither therapy had any effect on mortality or myocardial infarction rate. VBT reduced the rate of revascularisation (RR 0.59, 95%CI 0.50-0.68), MACE (RR 0.58, 95%CI 0.51-0.67), binary restenosis (RR 0.51, 95%CI 0.44-0.59) and late loss (-0.73 mm, 95%CI -0.91 to -0.55 mm) compared to balloon angioplasty and selective bare metal stents (BMS) alone at intermediate follow-up and MACE (RR 0.72, 95%CI 0.61-0.85) at long-term follow-up. DES reduced the rate of revascularisation (OR 0.51, 95% CI 0.36-0.71), MACE (OR 0.55, 95% CI 0.39-0.79) and binary restenosis (OR 0.57, 95% CI 0.40-0.81) compared to VBT but follow-up was limited to 9 months.
  
  
  CONCLUSIONS
  VBT improves the long-term outcome of angioplasty compared with BMS alone in the treatment of ISR. DES appears to provide similar results to that of VBT during short-term follow-up.
authors.affiliation: The Vascular Biology Unit, James Cook University, Townsville, Queensland, 4811, Australia.
authors.forename: Lisa N
authors.initials: LN
authors.lastname: Oliver
authors.forename: Petra G
authors.initials: PG
authors.lastname: Buttner
authors.forename: Helen
authors.initials: H
authors.lastname: Hobson
authors.forename: Jonathan
authors.initials: J
authors.lastname: Golledge
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D023903:Coronary Restenosis / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D054855:Drug-Eluting Stents; D006801:Humans; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic / Q000379:methods*