Background: In-stent restenosis (ISR) remains a significant challenge despite advancements in percutaneous interventions, often leading to adverse clinical outcomes. The neutrophil-to-lymphocyte ratio (NLR) has emerged as a potential biomarker for predicting ISR, offering opportunities for improved risk stratification and treatment personalization. This systematic review and meta-analysis assess the predictive value of NLR in ISR, providing insights into its clinical applicability. Methods: Systematic literature search was conducted in scientific databases until 21st July 2024. Observational studies evaluating NLR in stented patients were included. Random effect meta-analysis and linear regression model were used to investigate odds ratios (OR) as predictor and linear dose-response relationship of ISR. Sensitivity and specificity of NLR to predict this outcome were pooled and a summary receiver operating characteristics (sROC) curve was generated. This study was already registered in the PROSPERO (ID: CRD42024555123). Results: 15 studies with 3 889 patients were included. High NLR was associated with increased risk of ISR in coronary and non-coronary stenting [aOR = 1.61 (95%CI 1.14–2.25); aOR = 1.69 (95%CI 1.52–1.87)]. One unit increase of NLR is equal to 30% and 44% increased risk of ISR in coronary and non-coronary patients. Included studies showing NLR as a robust predictor of ISR with sensitivity and specificity of 70.5% (95%CI 60.1%-79.2%) and 74.1% (95%CI 56.7%-86.2%) for coronary stenting and 77.7% (95%CI 69.8%-84.0%) and 66.4% (95%CI 49.6%-79.8%) non-coronary stenting, with AUC of 0.77 (0.70–0.82) in the coronary and 0.79 (0.70–0.85) in the non-coronary sub-groups. Conclusion: In conclusion, NLR yields promising predictive and prognostic potentials in predicting ISR in coronary and non-coronary stents. Additionally, NLR appears to be more proficient in predicting early ISR compared to late ISR in both coronary and non-coronary stents.

Objectives: Ehlers–Danlos syndrome (EDS) is a group of connective tissue disorders characterized by mutations affecting collagen and extracellular matrix proteins. Vascular EDS (vEDS) stands out for its severe prognosis due to the heightened risk of arterial and organ rupture which significantly increase mortality rates. Limited strategies for treating vEDS are prompting exploration for alternatives such as celiprolol, a cardioselective beta-blocker with potential to reduce vascular stress and improve collagen integrity. This review aims to evaluate current evidence on the impact of celiprolol in managing vEDS. Methods: A comprehensive literature search was conducted across scientific databases for studies comparing celiprolol with placebo or other treatments, focusing on relevant outcomes. Results: A total of 323 participants were included across studies published from 2010 to 2023, primarily conducted in European settings. Celiprolol administration, starting at 100 mg daily and titrated up to 400 mg, significantly reduced the incidence of major vascular events such as arterial dissections and ruptures. Most studies reported improved survival rates and fewer hospitalizations due to acute arterial events. Variations in treatment response and side effects such as dizziness and hypotension were noted across studies, occasionally leading to treatment. Conclusions: Celiprolol appears to be a promising treatment for reducing vascular events in vEDS patients, potentially improving quality of life and mitigating the substantial morbidity and mortality associated with vEDS. Future research should focus on refining treatment protocols, exploring mechanisms of action, and establishing comprehensive clinical guidelines to optimize patient outcomes.

Context: This study observed the updates on in-stent restenosis (ISR) management results that compare the new generation drug-eluting balloon (DEB) and drug eluting stent (DES), particularly in small vessels. Aims: To compare studies focused on those researching ISR management updates that associated these two constructs in small vessels. Methods: A meta-analysis according to the PRISMA guidelines established in 2020 was followed. It incorporated 20 selected studies [eight randomized clinical trials (RCTs) and 12 observational studies] that examined research related to ISR management updates, comparing these two constructs in small vessels. Results: The findings indicated that TLR was more significant in DEB than in the new generation DES. In RCT studies, the results showed RR = 1.64, 95% CI: 1.18 to 2.28, p = 0.004, I2 = 46%. Meanwhile, observational studies reported RR = 1.26, 95% CI: 1.04 to 1.53, p = 0.02, I2 = 27%. Another observation was that MLD was more significant in the new generation DES compared to DEB. Results from RCTs revealed RR = -0.15, 95% CI: -0.21 to -0.10, p<0.001, I2 = 48%, while observational studies showed RR = -0.46, 95% CI: -0.56 to -0.37, p<0.001, I2 = 41%. Moreover, in studies focusing on small vessels, MLD was found to be significant in observational studies (RR = -0.63, 95% CI: -0.94 to -0.32, p<0.001). Additionally, MACE was significantly higher in the DEB group, with RCT RR = 1.30, 95% CI: 1.01 to 1.70, p = 0.04, I2 = 6%. Conclusions: This study suggests that both new generation DES and DEB are equally effective and safe for ISR management in major coronary and small vessels.