Drug-coated balloon angioplasty for in-stent restenosis of femoropopliteal arteries: A meta-analysis

Salvatore Cassese, Gjin Ndrepepa, Sebastian Kufner, Robert A. Byrne, Daniele Giacoppo, Ilka Ott, Karl Ludwig Laugwitz, Heribert Schunkert, Adnan Kastrati, Massimiliano Fusaro

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25 Scopus citations


Aims: Our aim was to perform a meta-analysis to investigate the outcomes of patients undergoing percutaneous revascularisation with drug-coated balloon (DCB) angioplasty because of femoropopliteal in-stent restenosis (ISR). Methods and results: We searched scientific databases for studies of DCB angioplasty for femoropopliteal ISR. The primary outcome was target lesion revascularisation (TLR). The main secondary outcome was recurrent ISR. Other outcomes of interest were Rutherford class (RC) improvement, ankle-brachial index (ABI) and death. A total of 367 patients enrolled in four studies received DCB (n=188) or plain balloon angioplasty (n=179). Median follow-up was 12 months. Patients treated with DCB angioplasty displayed a lower risk for TLR (odds ratio [OR] 0.20, 95% confidence interval [CI]: 0.07-0.55, p=0.002) and recurrent ISR (OR 0.24, 95% CI: 0.09-0.61, p=0.003), and a sustained RC improvement (OR 2.57, 95% CI: 1.40-4.72, p=0.002) with similar ABI and mortality as compared to those patients treated with plain balloon angioplasty. Conclusions: In comparison to plain balloon angioplasty, DCB therapy for femoropopliteal ISR is associated with superior clinical and antirestenotic efficacy. Further randomised trials comparing DCB with therapies alternative to plain balloon, in a larger number of patients, and with extended follow-up are needed to address definitively the role of DCB for femoropopliteal ISR.

Original languageEnglish
Pages (from-to)483-489
Number of pages7
Issue number4
StatePublished - Jul 2017


  • Drug-eluting balloon
  • Femoropopliteal disease
  • In-stent restenosis


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