Optimizing stent restenosis management: A meta-analysis of new generation drug-eluting stent versus drug-eluting balloon in small vessels

Context: This study observed the updates on in-stent restenosis (ISR) management results that compare the new generation drug-eluting balloon (DEB) and drug eluting stent (DES), particularly in small vessels. Aims: To compare studies focused on those researching ISR management updates that associated these two constructs in small vessels. Methods: A meta-analysis according to the PRISMA guidelines established in 2020 was followed. It incorporated 20 selected studies [eight randomized clinical trials (RCTs) and 12 observational studies] that examined research related to ISR management updates, comparing these two constructs in small vessels. Results: The findings indicated that TLR was more significant in DEB than in the new generation DES. In RCT studies, the results showed RR = 1.64, 95% CI: 1.18 to 2.28, p = 0.004, I2 = 46%. Meanwhile, observational studies reported RR = 1.26, 95% CI: 1.04 to 1.53, p = 0.02, I2 = 27%. Another observation was that MLD was more significant in the new generation DES compared to DEB. Results from RCTs revealed RR = -0.15, 95% CI: -0.21 to -0.10, p<0.001, I2 = 48%, while observational studies showed RR = -0.46, 95% CI: -0.56 to -0.37, p<0.001, I2 = 41%. Moreover, in studies focusing on small vessels, MLD was found to be significant in observational studies (RR = -0.63, 95% CI: -0.94 to -0.32, p<0.001). Additionally, MACE was significantly higher in the DEB group, with RCT RR = 1.30, 95% CI: 1.01 to 1.70, p = 0.04, I2 = 6%. Conclusions: This study suggests that both new generation DES and DEB are equally effective and safe for ISR management in major coronary and small vessels.