Reply to “Predictable Superiority of Everolimus-Eluting Stent Over Paclitaxel-Eluting Balloon in Patients with In-Stent Restenosis”

Abstract

We are grateful to Zago et al for their interest in our study and for their insightful comments. Actually, we fully agree with all their suggestions. In our report, we already acknowledged that only a specific drug-eluting balloon (DEB), using iopromide to elute paclitaxel, was used in the RIBS IV and V randomized clinical trials and, accordingly, that our findings only applied to patients treated with this particular device. However, this DEB was carefully selected for our trials precisely considering the strong evidence available, stemming from previous randomized clinical trials, supporting its effectiveness in patients with in-stent restenosis (ISR). 1 Alfonso F. Pérez-Vizcayno M.J. García Del Blanco B. García-Touchard A. Masotti M. López-Minguez J.R. Iñiguez A. Zueco J. Velazquez M. Cequier A. Lázaro-García R. Martí V. Moris C. Urbano-Carrillo C. Bastante T. Rivero F. Cárdenas A. Gonzalo N. Jiménez-Quevedo P. Fernández C. Comparison of the efficacy of everolimus-eluting stents versus drug-eluting balloons in patients with in-stent restenosis (from the RIBS IV and V Randomized clinical trials). Am J Cardiol. 2016; 117: 546-554 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar We also highlighted in our report that current clinical practice guidelines suggest that a class effect cannot be assumed for all DEB. 1 Alfonso F. Pérez-Vizcayno M.J. García Del Blanco B. García-Touchard A. Masotti M. López-Minguez J.R. Iñiguez A. Zueco J. Velazquez M. Cequier A. Lázaro-García R. Martí V. Moris C. Urbano-Carrillo C. Bastante T. Rivero F. Cárdenas A. Gonzalo N. Jiménez-Quevedo P. Fernández C. Comparison of the efficacy of everolimus-eluting stents versus drug-eluting balloons in patients with in-stent restenosis (from the RIBS IV and V Randomized clinical trials). Am J Cardiol. 2016; 117: 546-554 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar , 2 Windecker S. Kolh P. Alfonso F. Collet J.P. Cremer J. Falk V. Filippatos G. Hamm C. Head S.J. Jüni P. Kappetein A.P. Kastrati A. Knuuti J. Landmesser U. Laufer G. Neumann F.J. Richter D.J. Schauerte P. Sousa Uva M. Stefanini G.G. Taggart D.P. Torracca L. Valgimigli M. Wijns W. Witkowski A. 2014 ESC/EACTS Guidelines on Myocardial Revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014; 35: 2541-2619 Crossref PubMed Scopus (3892) Google Scholar Likewise, we selected a specific new-generation drug-eluting stent (DES) eluting everolimus as the comparator, as this particular DES is currently considered the best comparator for studies assessing the relative efficacy of other novel DES. Accordingly, using a pragmatic approach, our study simply compared the value of the 2, best-in-class, currently available therapeutic strategies for patients with ISR. 1 Alfonso F. Pérez-Vizcayno M.J. García Del Blanco B. García-Touchard A. Masotti M. López-Minguez J.R. Iñiguez A. Zueco J. Velazquez M. Cequier A. Lázaro-García R. Martí V. Moris C. Urbano-Carrillo C. Bastante T. Rivero F. Cárdenas A. Gonzalo N. Jiménez-Quevedo P. Fernández C. Comparison of the efficacy of everolimus-eluting stents versus drug-eluting balloons in patients with in-stent restenosis (from the RIBS IV and V Randomized clinical trials). Am J Cardiol. 2016; 117: 546-554 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar , 2 Windecker S. Kolh P. Alfonso F. Collet J.P. Cremer J. Falk V. Filippatos G. Hamm C. Head S.J. Jüni P. Kappetein A.P. Kastrati A. Knuuti J. Landmesser U. Laufer G. Neumann F.J. Richter D.J. Schauerte P. Sousa Uva M. Stefanini G.G. Taggart D.P. Torracca L. Valgimigli M. Wijns W. Witkowski A. 2014 ESC/EACTS Guidelines on Myocardial Revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014; 35: 2541-2619 Crossref PubMed Scopus (3892) Google Scholar We hypothesized that everolimus-DES would be superior to paclitaxel-DEB, and eventually, we could demonstrated that our hypothesis was correct. Expectation fulfilled. Predictable Superiority of Everolimus-Eluting Stent Over Paclitaxel-Eluting Balloon in Patients With In-Stent RestenosisAmerican Journal of CardiologyVol. 120Issue 3PreviewWe read with great interest the study performed by Alfonso et al1 comparing the efficacy of everolimus-eluting stents (EES) and drug-eluting balloons (DEB) in patients with in-stent restenosis (ISR). We appreciate their findings; however, we would like to discuss some issues. In fact, the comparison was between EES and paclitaxel-eluting balloon (PEB). Being so, 2 subjects were compared, that is, 2 different devices (drug-eluting balloon vs drug-eluting stent) and 2 different drugs (everolimus vs paclitaxel). Full-Text PDF