Effectiveness of in-stent restenosis treatment using drug-eluting stents, paclitaxel-coated balloons, and sirolimus-coated balloons in managing complications after PCI in atherosclerosis patients

Introduction: Coronary artery disease (CAD) is one of the leading causes of death worldwide. One of the primary causes of CAD is atherosclerosis. One of the management strategies for atherosclerosis is Percutaneous Coronary Intervention (PCI) using drug-eluting stents (DES). This procedure involves the insertion of a catheter to place a stent that opens narrowed blood vessels due to plaque accumulation. However, this procedure may be repeated due to complications such as in-stent restenosis (ISR), which is the re-narrowing of the arterial lumen after stent placement, caused by intimal hyperplasia. Two endovascular interventions that can be options for treating ISR are re-implantation of a DES or the use of drug-coated balloons (DCB). DCB presents an alternative to re-stenting. There are two DCB treatment options: Paclitaxel Coated Balloon (PCB) and Sirolimus Coated Balloon (SCB), whose effectiveness will be compared. Methods: This literature review is written as a result of various interrelated literature studies, supported by analytical discussions. Literature search sources used six databases namely PubMed, Web of Science, Scopus, CINAHL, Proquest, and Cochrane with published years 2014-2024. The types of studies included are full text articles, systematic review, meta-analysis, randomized controlled trials, and case-control study. Summary: Both DCBs showed nearly identical angiographic courses with very low lumen narrowing in this high-risk group in the treatment of DES restenosis after 6 months. This is the first indication that SCB is as effective as the best-in-class PCB.