title: Drug-eluting balloon angioplasty for in-stent restenosis: a systematic review and meta-analysis of randomised controlled trials.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Trials were identified through a literature search from 2005 through 7 November 2012.
  
  
  METHODS
  Randomised clinical trials comparing DEB with a control treatment (plain balloon angioplasty or drug-eluting stents).
  
  
  METHODS
  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.
authors: Department of Cardiology, University College London Hospital, London, UK.
authors: Andreas
authors: A
authors: Indermuehle
authors: Rahul
authors: R
authors: Bahl
authors: Alexandra J
authors: AJ
authors: Lansky
authors: Georg M
authors: GM
authors: Froehlich
authors: Guido
authors: G
authors: Knapp
authors: Adam
authors: A
authors: Timmis
authors: Pascal
authors: P
authors: Meier
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D054855:Drug-Eluting Stents; D006801:Humans; D011474:Prosthesis Design; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome