A Meta-analysis Of The Safety And Efficacy Of Novel Excimer Laser Coronary Artery Ablation For In Stent Restenosis

Background:with the widespread use of drug-coated stents,the incidence of coronary stent restenosis(ISR)has decreased significantly,but the incidence of ISR in real-world complex lesions can still exceed 10% [1].In patients undergoing percutaneous coronary intervention(PCI)with contemporary drug-eluting stents,in-stent restenosis(ISR)occurs in the first year but continues to occur in subsequent years[2].In the United States alone,more than 150,000 patients are diagnosed with in-stent restenosis(ISR)each year,and it is well known that coronary stent restenosis is determined by early elastic recoiling,subsequent contraction of dilated vessels,thrombosis at the dilated site,primary proliferation and migration to endometrial tissue,and excessive production of extracellular matrix [3].Although a number of therapeutic approaches have been used for ISR,such as spinous balloon,cutting balloon,drug balloon,or drug stent,the therapeutic efficacy remains controversial.Excimer laser coronary atherosclectomy(ELCA)is considered to be a favorable method for the treatment of ISR by neointima dedilation [4].Clinical studies in 2020 have shown that the combined application of ELCA and DCB in the treatment of ISR can enhance the advantages of ELCA and DCB,give full play to the advantages of ELCA and DCB,and obtain a larger immediate lumen without increasing the incidence of complications [1].However,the safety and efficacy of ELCA in the treatment of ISR is still being explored.Objective:To evaluate the safety and efficacy of new excimer laser coronary artery ablation in coronary stent restenosis.METHODS: Computer databases were searched from January 2000 to December 31,2020,including Pub Med,Embase,The Cochranelibrary,CNKI,Wanfang Database,VIP,CBM,etc.The search language is restricted to Chinese and English.English term for "Excimerlasercoronaryarteryr-esection" AND "instentrestenosis",Chinese word retrieval for coronary stent restenosis AND "new excimer laser ablation coronary arteries.Review Manager5.3.5was used for all data analyses.Study indicators included myocardial infarction(MI),major adverse cardiovascular events(MACE),target lesion revascularization(TLR).RESULTS:Four eligible studies were finally included,including one RCT and three RCs,all in English.A total of 243 patients were treated.Conclusion: novel excimer laser coronary artery ablation provides a new treatment strategy for patients with coronary stent restenosis.This study shows that the new excimer laser coronary artery ablation is safe and effective in the application of coronary stent restenosis.Because of the potential importance of ELCA for ISR treatment,it is reasonable to conduct a randomized trial in a large number of patients.