Paclitaxel-Eluting vs. Sirolimus-Eluting Balloons

Coronary restenosis remains one of the main challenges in percutaneous transluminal coronary angioplasty (PTCA), especially nowadays, when procedures are increasingly complex and more stents are used, particularly in older patients.

Drug-eluting balloons (DEB) have proven to be beneficial in this scenario, according to several studies. Currently, there are paclitaxel- and sirolimus-eluting balloons, each with distinct characteristics. However, it is still unclear which of these drugs is superior or which circumstances would make one or the other more appropriate to use.

Researchers conducted a meta-analysis that included 1861 patients (from 5 randomized studies and 3 observational studies). Of these, 889 received paclitaxel-eluting balloons (PEB) and the rest received sirolimus-eluting balloons (SEB). Both de novo lesions and restenosis cases were included.

The assessment included clinical and angiographic events between 6 and 12 months of follow-up.

There were no significant differences between the groups in terms of the composite of cardiac death, myocardial infarction, or target vessel failure (odds ratio [OR] 1.01; 95% confidence interval [CI]: 0.75–1.35; I² = 0.0%). There were also no differences in cardiac mortality, myocardial infarction, or need for target lesion revascularization (TLR), which was consistent across both randomized and observational studies.

Read also: Plaque Morphology and Stent Elongation Assessed by OCT.

In the angiographic follow-up, patients who received PEB had a larger minimum luminal diameter compared to those who received SEB (0.10 mm, 95% CI: 0.02–0.17). This difference was more pronounced in de novo lesions than in restenosis cases.

Late lumen loss (the difference between the minimum luminal diameter during the procedure and at follow-up angiography) was also lower in patients treated with PEB compared with those who received SEB (-0.11 mm, 95% CI: -0.23 to 0.02; I² = 57.1%), although this difference was not statistically significant.

Conclusion:

At 9 and 12 months of follow-up, the rate of target lesion failure (TLF) was similar between the PEB and SEB groups. However, in the angiographic follow-up, the minimum luminal diameter was greater in patients who received PEB.

Original Title: Paclitaxel‐coated versus sirolimus‐coated balloon angioplasty for coronary artery disease: A systematic review and meta‐analysis.

Reference: Doosup Shin, et al. Catheter Cardiovasc Interv. 2024;104:425–436.