Abstract Body (Do not enter title and authors here): Background: The rate of in-stent restenosis (ISR) in clinical practice is approximately 5-10% after 5 years of percutaneous coronary intervention for coronary artery disease. ISR is associated with a high risk of adverse events. The current literature comparing drug-eluting stents (DES) to drug-eluting balloons (DEB) for ISR has yielded divergent results, prompting this meta-analysis.

Methods: A comprehensive systematic literature review was conducted across major electronic databases, from inception to May 20, 2024. The search was aimed at identifying studies that compared DCB with DES for ISR. Using an inverse-variance random-effects model, we pooled odds ratios (OR) and mean differences (MD) with their respective 95% confidence intervals (CI). Statistical significance was set at p<0.05.

Results: Twelve studies encompassing 2362 patients with CAD (1250: DCB and 1112: DES) were included. Pooled analysis demonstrated that DCB was associated with a significantly lower mean lumen diameter at follow-up [MD: -0.17; 95% CI: -0.27, -0.07; p<0.001] than DES. However, there was no statistically significant difference in mean in-stent late lumen loss [MD: -0.06; 95% CI: -0.16, 0.04], cardiovascular mortality [OR: 0.74; 95% CI: 0.36, 1.51], all-cause mortality [OR: 0.78; 95% CI: 0.45, 1.35], myocardial infarction [OR: 0.75; 95% CI: 0.48, 1.18], major adverse cardiovascular events [OR: 1.16; 95% CI: 0.85, 1.58], target lesion revascularization [OR: 1.52; 95% CI: 0.99, 2.32], and stent thrombosis [OR: 0.84; 95% CI: 0.27, 2.58].

Conclusion: ISR treatment with DCB was associated with a lower minimum lumen diameter at follow-up than DES. No significant differences were noted in the other outcomes. Additional appropriately powered trials with larger patient populations are necessary to confirm our findings.