Drug coated balloons for coronary artery bifurcation lesions: A systematic review and focused meta-analysis.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2021
2021
Historique:
received:
30
03
2021
accepted:
07
05
2021
entrez:
9
7
2021
pubmed:
10
7
2021
medline:
29
10
2021
Statut:
epublish
Résumé
We sought to systematically review the evidence supporting the role of drug coated balloons (DCBs) in the treatment of coronary bifurcation lesions. DCBs are emerging as an attractive alternative treatment strategy for treating coronary bifurcations due to simplifying the approach and reducing rates of stent related complications. We systematically reviewed the evidence for DCB use in coronary bifurcations and conducted a focused meta-analysis on late lumen loss in the side branch comparing DCB and plain old balloon angioplasty (POBA). This study was conducted in line with the PRISMA statement. All studies (including both RCTs and observational studies, excluding case reports) using DCB as part of a bifurcation strategy were included in this review. A literature search identified a total of ten studies for inclusion. A focused meta-analysis was undertaken for the use of DCB in side-branch compared with POBA. Mean late lumen loss was used with a random effects model due to heterogeneity. DCB was found to be superior to POBA for side branch treatment in bifurcations (p = 0.01). There are four studies that investigated the use of DCB for main branch treatment in a bifurcation, with evidence supporting its safety in main branches of bifurcation lesions, while prospective observational studies have demonstrated favourable target lesion revascularisation rates. Although there is a lack of robust RCTs comparing DCBs with current generation DES, DCBs appear safe in main branch bifurcation lesions with improved side branch late lumen loss when compared with DES or POBA.
Sections du résumé
OBJECTIVES
We sought to systematically review the evidence supporting the role of drug coated balloons (DCBs) in the treatment of coronary bifurcation lesions.
BACKGROUND
DCBs are emerging as an attractive alternative treatment strategy for treating coronary bifurcations due to simplifying the approach and reducing rates of stent related complications. We systematically reviewed the evidence for DCB use in coronary bifurcations and conducted a focused meta-analysis on late lumen loss in the side branch comparing DCB and plain old balloon angioplasty (POBA).
METHODS
This study was conducted in line with the PRISMA statement. All studies (including both RCTs and observational studies, excluding case reports) using DCB as part of a bifurcation strategy were included in this review. A literature search identified a total of ten studies for inclusion. A focused meta-analysis was undertaken for the use of DCB in side-branch compared with POBA. Mean late lumen loss was used with a random effects model due to heterogeneity.
RESULTS
DCB was found to be superior to POBA for side branch treatment in bifurcations (p = 0.01). There are four studies that investigated the use of DCB for main branch treatment in a bifurcation, with evidence supporting its safety in main branches of bifurcation lesions, while prospective observational studies have demonstrated favourable target lesion revascularisation rates.
CONCLUSION
Although there is a lack of robust RCTs comparing DCBs with current generation DES, DCBs appear safe in main branch bifurcation lesions with improved side branch late lumen loss when compared with DES or POBA.
Identifiants
pubmed: 34242214
doi: 10.1371/journal.pone.0251986
pii: PONE-D-21-09572
pmc: PMC8270410
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0251986Déclaration de conflit d'intérêts
Vassilios Vassiliou reports speaker fees from Medtronic and Daichii-Sankyo and received a grant for investigator-initiated research. Simon Eccleshall received speaker fees and acts as a consultant for B Braun and received grants for investigator-initiated research. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
Références
Yonsei Med J. 2016 May;57(3):606-13
pubmed: 26996558
Eur Heart J. 2019 Jan 7;40(2):87-165
pubmed: 30165437
Circulation. 2010 Mar 16;121(10):1235-43
pubmed: 20194880
Lancet. 2018 Sep 8;392(10150):849-856
pubmed: 30170854
Circulation. 2012 Jun 12;125(23):2873-91
pubmed: 22586281
Korean Circ J. 2018 Jun;48(6):481-491
pubmed: 29856142
Cardiovasc Interv Ther. 2020 Oct 10;:
pubmed: 33037991
Clin Res Cardiol. 2021 Feb;110(2):220-227
pubmed: 32876814
J Interv Cardiol. 2013 Oct;26(5):454-62
pubmed: 24106744
Clin Res Cardiol. 2016 Jul;105(7):613-21
pubmed: 26768146
Circ Cardiovasc Interv. 2011 Feb 1;4(1):9-14
pubmed: 21266707
EuroIntervention. 2014 Sep;10(5):545-60
pubmed: 25256198
Clin Res Cardiol. 2014 Jun;103(6):451-6
pubmed: 24522798
Cardiovasc Revasc Med. 2015 Oct-Nov;16(7):413-7
pubmed: 26346023
Expert Rev Cardiovasc Ther. 2018 Oct;16(10):725-734
pubmed: 30221565
J Interv Cardiol. 2016 Jun;29(3):285-92
pubmed: 27245124
Eur Heart J. 2016 Jun 21;37(24):1923-8
pubmed: 27161619
J Interv Cardiol. 2016 Aug;29(4):348-56
pubmed: 27242273
Circulation. 2011 Jan 4;123(1):79-86
pubmed: 21173348
JACC Cardiovasc Interv. 2020 Jun 22;13(12):1391-1402
pubmed: 32473887
EuroIntervention. 2014 May;10(1):50-7
pubmed: 24832638
EuroIntervention. 2021 Mar 19;16(16):1307-1317
pubmed: 33074152
EuroIntervention. 2011 May;7 Suppl K:K61-5
pubmed: 22027730
Catheter Cardiovasc Interv. 2012 Dec 1;80(7):1138-46
pubmed: 22422607