PDF(Pubmed)
Abstract：
UNASSIGNED: In-stent restenosis (ISR) has become a significant obstacle to interventional therapy for atherosclerotic cardiovascular disease. The optimal percutaneous coronary intervention (PCI) strategy for patients with coronary ISR remains controversial. This network meta-analysis (NMA) was aimed to compare and estimate the effectiveness of different PCI strategies and commercial devices for the treatment of patients with coronary ISR.
UNASSIGNED: In present study, we systematically searched PubMed, Embase, Web of Science, and Cochrane Library from database inception to October 20, 2022, to identify randomized controlled trials. We included studies comparing various PCI strategies for the treatment of any type of coronary ISR. The study was registered with PROSPERO, CRD 42022364308.
UNASSIGNED: We included 44 eligible trials including 8479 patients, 39 trials comparing the treatment effects of 10 PCIs, and 5 trials comparing the efficacy between different types of drug-eluting stent (DES) or drug-coated balloon (DCB) devices. Among the PCIs, everolimus-eluting stent was the optimal strategy considering target lesion revascularization (TLR), percent diameter stenosis (%DS), and binary restenosis (BR), and sirolimus-coated balloon was the optimal strategy considering late lumen loss (LLL). In the comparison of commercial devices, the combination strategy excimer laser coronary angioplasty plus SeQuent Please paclitaxel-coated balloon showed promising therapeutic prospects.
UNASSIGNED: DCB and DES remain the preferred treatment strategies for coronary ISR, considering both the primary clinical outcome (TLR) and the angiographic outcomes (LLL, BR, %DS). Personalized combination interventions including DCB or DES hold promise as a novel potential treatment pattern for coronary ISR.
UNASSIGNED: In present study, we systematically searched PubMed, Embase, Web of Science, and Cochrane Library from database inception to October 20, 2022, to identify randomized controlled trials. We included studies comparing various PCI strategies for the treatment of any type of coronary ISR. The study was registered with PROSPERO, CRD 42022364308.
UNASSIGNED: We included 44 eligible trials including 8479 patients, 39 trials comparing the treatment effects of 10 PCIs, and 5 trials comparing the efficacy between different types of drug-eluting stent (DES) or drug-coated balloon (DCB) devices. Among the PCIs, everolimus-eluting stent was the optimal strategy considering target lesion revascularization (TLR), percent diameter stenosis (%DS), and binary restenosis (BR), and sirolimus-coated balloon was the optimal strategy considering late lumen loss (LLL). In the comparison of commercial devices, the combination strategy excimer laser coronary angioplasty plus SeQuent Please paclitaxel-coated balloon showed promising therapeutic prospects.
UNASSIGNED: DCB and DES remain the preferred treatment strategies for coronary ISR, considering both the primary clinical outcome (TLR) and the angiographic outcomes (LLL, BR, %DS). Personalized combination interventions including DCB or DES hold promise as a novel potential treatment pattern for coronary ISR.
摘要：
■支架内再狭窄（ISR）已成为动脉粥样硬化性心血管疾病介入治疗的重要障碍。冠状动脉ISR患者的最佳经皮冠状动脉介入治疗（PCI）策略仍存在争议。该网络荟萃分析（NMA）旨在比较和评估不同PCI策略和商业设备治疗冠状动脉ISR患者的有效性。
■在本研究中，我们系统地搜索了PubMed,Embase,WebofScience,和Cochrane图书馆从数据库开始到2022年10月20日，以确定随机对照试验。我们纳入了比较各种PCI策略治疗任何类型冠状动脉ISR的研究。这项研究在PROSPERO注册，CRD42022364308。
■我们纳入了44项符合条件的试验，包括8479名患者，39项试验比较了10项PCI的治疗效果，和5项试验比较了不同类型的药物洗脱支架（DES）或药物涂层球囊（DCB）装置之间的疗效。在PCI中，依维莫司洗脱支架是考虑靶病变血运重建（TLR）的最佳策略，直径狭窄百分比(%DS)，和二元再狭窄(BR)，考虑到晚期管腔损失（LLL），西罗莫司涂层球囊是最佳策略。在商业设备的比较中，准分子激光冠状动脉成形术加SeQuentPlease紫杉醇涂层球囊的组合策略显示出良好的治疗前景。
■DCB和DES仍然是冠状动脉ISR的首选治疗策略，考虑到主要临床结果(TLR)和血管造影结果(LLL，BR,%DS）。包括DCB或DES在内的个性化组合干预有望成为冠状动脉ISR的新型潜在治疗模式。
■在本研究中，我们系统地搜索了PubMed,Embase,WebofScience,和Cochrane图书馆从数据库开始到2022年10月20日，以确定随机对照试验。我们纳入了比较各种PCI策略治疗任何类型冠状动脉ISR的研究。这项研究在PROSPERO注册，CRD42022364308。
■我们纳入了44项符合条件的试验，包括8479名患者，39项试验比较了10项PCI的治疗效果，和5项试验比较了不同类型的药物洗脱支架（DES）或药物涂层球囊（DCB）装置之间的疗效。在PCI中，依维莫司洗脱支架是考虑靶病变血运重建（TLR）的最佳策略，直径狭窄百分比(%DS)，和二元再狭窄(BR)，考虑到晚期管腔损失（LLL），西罗莫司涂层球囊是最佳策略。在商业设备的比较中，准分子激光冠状动脉成形术加SeQuentPlease紫杉醇涂层球囊的组合策略显示出良好的治疗前景。
■DCB和DES仍然是冠状动脉ISR的首选治疗策略，考虑到主要临床结果(TLR)和血管造影结果(LLL，BR,%DS）。包括DCB或DES在内的个性化组合干预有望成为冠状动脉ISR的新型潜在治疗模式。
