Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Apr 26, 2021; 13(4): 95-102
Published online Apr 26, 2021. doi: 10.4330/wjc.v13.i4.95
Intracoronary brachytherapy for the treatment of recurrent drug-eluting stent in-stent restenosis: A systematic review and meta-analysis
Irtqa Ilyas, Ashish Kumar, Devina Adalja, Mariam Shariff, Rupak Desai, Yasar Sattar, Saraschandra Vallabhajosyula, Nageshwara Gullapalli, Rajkumar Doshi
Irtqa Ilyas, Nageshwara Gullapalli, Rajkumar Doshi, Department ofInternal Medicine, University of Nevada Reno School of Medicine, Reno, NV 89509, United States
Ashish Kumar, Mariam Shariff, Department of Critical Care Medicine, Saint John's Medical College Hospital, Bangalore 560034, Karnataka, India
Devina Adalja, Department of Internal Medicine, GMERS Gotri Medical College, Vadodara 380021, Gujarat, India
Rupak Desai, Department of Cardiology, Atlanta VA Medical Center, Decatur, GA 30033, United States
Yasar Sattar, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Elmhurst, New York, NY 11373, United States
Saraschandra Vallabhajosyula, Interventional Cardiology, Emory University, Atlanta, GA 30322, United States
Author contributions: Ilyas I, Adalja D, Shariff M, Kumar A, Desai R, Sattar Y, Vallabhajosyula S, Doshi R, and Gullapalli N performed the conceptualization, methodology, writing, reviewed and edited the manuscript; Kumar A, Desai R, Sattar Y, Vallabhajosyula S and Doshi R performed the software, formal analysis; Vallabhajosyula S, Gullapalli N and Doshi R supervised the manuscript.
Conflict-of-interest statement: There is no conflict of interest for any of the author in this manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 checklist, and the manuscript was prepared and revised according to the PRISMA 2009 checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rajkumar Doshi, MD, Attending Doctor, Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 W11 Mill St, Reno, NV 89509, United States. raj20490@gmail.com
Received: December 13, 2020
Peer-review started: December 13, 2020
First decision: February 28, 2021
Revised: March 8, 2021
Accepted: March 22, 2021
Article in press: March 22, 2021
Published online: April 26, 2021
Processing time: 128 Days and 10.9 Hours
Abstract
BACKGROUND

We performed a meta-analysis on observational studies since randomized control trials are not available. We studied intracoronary brachytherapy (ICBT) and recurrent drug eluting stent in-stent restenosis (DES-ISR) to evaluate the procedural success, target lesion revascularization (TLR), incidence of myocardial infarction (MI) and all-cause mortality at 2 years follow-up.

AIM

To perform meta-analysis for patients undergoing ICBT for recurrent DES-ISR.

METHODS

We performed a systematic search of the PubMed/MEDLINE, Cochrane and DARE databases to identify relevant articles. Studies were excluded if intra-coronary brachytherapy was used as a treatment modality for initial ISR and studies with bare metal stents. We used a random-effect model with DerSimonian & Laird method to calculate summary estimates. Heterogeneity was assessed using I2 statistics.

RESULTS

A total of 6 observational studies were included in the final analysis. Procedural angiographic success following intra-coronary brachytherapy was 99.8%. Incidence of MI at 1-year was 2% and 4.1% at 2-years, respectively. The incidence of TLR 14.1% at 1-year and 22.7% at 2-years, respectively. All-cause mortality at 1- and 2-year follow-up was 3% and 7.5%, respectively.

CONCLUSION

Given the observational nature of the studies included in the analysis, heterogeneity was significantly higher for outcomes. While there are no randomized controlled trials or definitive guidelines available for recurrent ISR associated with DES, this analysis suggests that brachytherapy might be the alternative approach for recurrent DES-ISR. Randomized controlled trials are required to confirm results from this study.

Keywords: Intracoronary brachytherapy; In-stent restenosis; Meta-analysis; Drug eluting stent; Systematic review; Brachytherapy

Core Tip: Information is not readily available for the management of recurrent drug-eluting in-stent restenosis. There have been recent advances in the management of in-stent restenosis. While the use of a drug-eluting stent is still associated with in-stent restenosis, the use of intracoronary brachytherapy (ICBT) has resurged as one of the modalities in the management of such a complex problem. This analysis focuses on myocardial infarction and target lesion revascularization after the use of ICBT with a follow-up out to 2 years. Future studies with longer follow up are required to see if these benefits last longer.