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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. 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. 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. 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.
Shrestha et al. (Wed,) studied this question.