title: Management of drug eluting stent in-stent restenosis: A systematic review and meta-analysis.
abstract: BACKGROUND
  The optimal management for coronary drug eluting stent in-stent restenosis (DES ISR) is unclear. We performed a meta-analysis of observational and randomized studies to compare the outcomes of management of DES ISR using DES, drug eluting balloon (DEB), or balloon angioplasty (BA).
  
  
  METHODS
  Eligible studies (25 single arm and 13 comparative, including 4 randomized studies with a total of 7,474 patients with DES ISR) were identified using MEDLINE search and proceedings of international meetings. Outcomes studied include major adverse cardiac events (MACE), target lesion revascularization (TLR), target vessel revascularization (TVR), myocardial infarction (MI), stent thrombosis (ST), and mortality. Follow-up ranged from 0.5 to 3.5 years (mean 1.4 years).
  
  
  RESULTS
  The rate of TLR was significantly lower in the DES (odds ratio [OR] 0.50, 95% confidence interval [CI] 0.36-0.69) and DEB (OR 0.31, 95% CI 0.18-0.55) groups compared to BA. Similarly, TVR rate was significantly lower in the DES (OR 0.55, 95% CI 0.39-0.77) and DEB (OR 0.32, 95% CI 0.18-0.58) groups compared to BA. All other outcomes were similar between the DES/BA and DEB/BA comparisons. TLR was significantly lower in the DES group compared to BA for vessels < or > 2.75 mm.
  
  
  CONCLUSIONS
  Treatment of coronary DES ISR with DES or DEB is associated with a reduction in the risk of TLR and TVR compared to BA alone. The relative risk reduction for TLR with DES is similar to DEB. DEBs have a potential role in the treatment of DES ISR by avoiding placement of another layer of stent. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Prairie Cardiovascular Consultants at St John's Hospital, Springfield, Illinois.
authors.forename: Sachin S
authors.initials: SS
authors.lastname: Goel
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Rama
authors.initials: R
authors.lastname: Dilip Gajulapalli
authors.affiliation: Mount Sinai Medical Center, New York, New York.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Athappan
authors.affiliation: Division of Cardiovascular Medicine, University of California (Davis) Medical Center, Sacramento, California.
authors.forename: Femi
authors.initials: F
authors.lastname: Philip
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Supriya
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: E
authors.initials: E
authors.lastname: Murat Tuzcu
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Ellis
authors.affiliation: Prairie Cardiovascular Consultants at St John's Hospital, Springfield, Illinois.
authors.forename: Gregory
authors.initials: G
authors.lastname: Mishkel
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Samir R
authors.initials: SR
authors.lastname: Kapadia
mesh_terms: D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000175:diagnosis / Q000628:therapy*; D019468:Disease Management; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D006801:Humans; D011474:Prosthesis Design; D011475:Prosthesis Failure
keywords: balloon; drug coated/eluting; drug eluting; stent; stent restenosis