Endovascular revascularization strategies for aortoiliac and femoropopliteal artery disease: a meta-analysis

作者：David Koeckerling, Peter Francis Raguindin, Lum Kastrati, Sarah Bernhard, Joseph Barker, A. Centeno, Hamidreza Raeisi‐Dehkordi, Farnaz Khatami, Christa D. Niehot, Anne Lejay, Zoltán Szeberin, Christian‐Alexander Behrendt, Joakim Nordanstig, Taulant Muka, Iris Baumgärtner · 发表于：European Heart Journal · 年份：2023 · DOI：10.1093/eurheartj/ehac722 · 被引用次数：72 · 研究领域：Peripheral Artery Disease Management、Renal and Vascular Pathologies、Aortic aneurysm repair treatments

AIMS: Optimal endovascular management of intermittent claudication (IC) remains disputed. This systematic review and meta-analysis compares efficacy and safety outcomes for balloon angioplasty (BA), bare-metal stents (BMS), drug-coated balloons (DCB), drug-eluting stents (DES), covered stents, and atherectomy. METHODS AND RESULTS: Electronic databases were searched for randomized, controlled trials (RCT) from inception through November 2021. Efficacy outcomes were primary patency, target-lesion revascularization (TLR), and quality-of-life (QoL). Safety endpoints were all-cause mortality and major amputation. Outcomes were evaluated at short-term (<1 year), mid-term (1-2 years), and long-term (≥2 years) follow-up. The study was registered on PROSPERO (CRD42021292639). Fifty-one RCTs enrolling 8430 patients/lesions were included. In femoropopliteal disease of low-to-intermediate complexity, DCBs were associated with higher likelihood of primary patency [short-term: odds ratio (OR) 3.21, 95% confidence interval (CI) 2.44-4.24; long-term: OR 2.47, 95% CI 1.93-3.16], lower TLR (short-term: OR 0.33, 95% CI 0.22-0.49; long-term: OR 0.42, 95% CI 0.29-0.60) and similar all-cause mortality risk, compared with BA. Primary stenting using BMS was associated with improved short-to-mid-term patency and TLR, but similar long-term efficacy compared with provisional stenting. Mid-term patency (OR 1.64, 95% CI 0.89-3.03) and TLR (OR 0.50, 95% CI 0.22-1.11) estimates were comparable for DES vs. ...