Journal of the Society for Cardiovascular Angiography & Interventions (Mar 2022)

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

  • Khalid Changal, MD,
  • Mitra Patel, MD,
  • Pratyush Pavan Devarasetty, BS,
  • Rachel Royfman, BS,
  • Spiro Veria, BS,
  • Rohit Vyas, MD,
  • Mohammed Mhanna, MD,
  • Neha Patel, MD,
  • Azizullah Beran, MD,
  • Mark Burket, MD,
  • Rajesh Gupta, MD

Journal volume & issue
Vol. 1, no. 2
p. 100024

Abstract

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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.

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