Net meta-analysis: comparison of bare metal stent, drug-coated balloon and drug-eluting stent in the treatment of cerebral arterial stenosis.

Objective: Previous studies compared drug-eluting stents (DES) or drug-coated balloons (DCB) with bare metal stents (BMS), but no direct comparisons of the three devices exist. This network meta-analysis assesses outcomes differences among DES, DCB, and BMS in cerebral arterial stenosis. Methods: We screened literature from PubMed, Embase, Web of Science, and Cochrane databases published from January 1, 2010 to March 9, 2025, on clinical studies comparing the three devices. Two researchers independently screened the articles using Endnote software, assessed their quality using the Newcastle-Ottawa Scale (NOS) and Cochrane Risk of Bias 2.0 tools, and performed STATA 14.0 with the "network" command. Results: Meta-analysis indicated associations in restenosis between DCB and BMS (odds ratio (OR): 0.24, 95%confidence interval (CI): 0.10-0.57), DES and BMS (OR: 0.37, 95%CI: 0.22-0.64). However, no significant difference was observed between DCB and DES. There was no statistical difference among different types of instruments in teach success. DCB was associated with higher risks of rescue procedures compared to BMS (OR: 3.41, 95%CI: 1.13-10.25). However, DCB was linked to reduction in perioperative complications compared to both BMS (OR: 0.3, 95%CI: 0.12-0.93) and DES (OR: 0.43, 95%CI: 0.19-0.95). In subgroup analysis by follow-up times, BMS was correlated with higher risks of restenosis compared with both DCB (OR: 9.06, 95% CI: 2.43-33.83) and DES (OR: 3.71, 95%CI: 1.27-10.83) within 6 months. Beyond 6 months, while DCB showed a favorable trend in restenosis compared to BMS, the advantage associated with DES was more pronounced (OR: 2.38, 95%CI: 1.19-4.75). BMS was linked to a higher risk of restenosis compared to DES in both intracranial artery stenosis (ICAS) (OR: 4.32, 95%CI: 2.45-7.62) and vertebral artery stenosis (VAS) (OR: 2.40, 95%CI: 1.25-4.59). Conclusion: In ICAS or VAS patients, DCB appeared to demonstrate comparable efficacy to DES in reducing restenosis, with both potentially superior to BMS. The advantage of DCB may be more pronounced within 6 months, whereas DES may exhibit potential sustained benefits beyond this period. DCB may also be associated with fewer perioperative complications, though they carried a higher likelihood of requiring urgent stent replacement. The comparable outcomes between DCB and DES suggested that both may be valuable endovascular options, forming a basis for clinical decision-making pending further evidence.