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Review
. 2022 Apr 11;1(2):100024.
doi: 10.1016/j.jscai.2022.100024. eCollection 2022 Mar-Apr.

Drug-Eluting Stents Versus Conventional Endovascular Therapies in Symptomatic Infrapopliteal Peripheral Artery Disease: A Meta-analysis

Khalid Changal  1 , Mitra Patel  2 , Pratyush Pavan Devarasetty  3 , Rachel Royfman  3 , Spiro Veria  3 , Rohit Vyas  1 , Mohammed Mhanna  2 , Neha Patel  2 , Azizullah Beran  2 , Mark Burket  1 , Rajesh Gupta  1
Affiliations
Review

Drug-Eluting Stents Versus Conventional Endovascular Therapies in Symptomatic Infrapopliteal Peripheral Artery Disease: A Meta-analysis

Khalid Changal et al. J Soc Cardiovasc Angiogr Interv. .

Abstract

Background: Balloon angioplasty is the standard endovascular treatment for symptomatic infrapopliteal peripheral artery disease (PAD). However, recent trials have studied the effectiveness of drug-eluting stents (DES) for infrapopliteal PAD.

Objective: This study investigated the use of DES compared with standard endovascular techniques for treatment of infrapopliteal artery disease.

Methods: This is a comprehensive systematic review and meta-analysis of 9 recent randomized controlled trials. The primary clinical outcome assessed was primary patency. The secondary outcomes were target lesion revascularization (TLR), major limb amputation, and all-cause mortality.

Results: A total of 945 patients met the inclusion criteria. Patients treated with DES were found to have increased primary patency than control at maximum follow-up (hazard ratio [HR] 2.17, 95% confidence interval [CI] 1.58-2.97, P < .0001, I2 = 62%). A similar result was seen in the subgroup of patients with critical limb ischemia (HR 2.58, 95% CI 1.49-4.49, P = .0008, I2 = 75%). DES were associated with significantly lower rates of TLR than control at maximum follow-up (HR 0.48, 95% CI 0.33-0.68, P < .0001; I2 = 11%). There was no statistical difference between DES versus control in rates of major limb amputation and mortality.

Conclusions: DES have superior primary patency and TLR rates with no difference in amputation and all-cause mortality rates compared with conventional endovascular therapies in patients with infrapopliteal PAD.

Keywords: Drug-eluting stents; angioplasty; critical limb ischemia; infrapopliteal PAD; peripheral artery disease.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Identification of studies via databases and using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.
Figure 2
Figure 2
Primary patency results for DES versus control. DES, drug-eluting stent.
Figure 3
Figure 3
Target lesion revascularization outcomes for DES versus control. DES, drug-eluting stent.
Figure 4
Figure 4
Major amputation occurrence among DES versus control. DES, drug-eluting stent.
Figure 5
Figure 5
All-cause mortality rates among DES versus control. DES, drug-eluting stent.
Central Illustration
Central Illustration
Drug-eluting stents are superior to conventional endovascular therapies for symptomatic infrapopliteal peripheral artery disease.
See this image and copyright information in PMC

References

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