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Frontiers in Cardiovascular Medicine 2022Endovascular treatment has become the first-line therapy for infrapopliteal artery occlusive disease (IPOD), while the optimal endovascular method remains to be...
BACKGROUND
Endovascular treatment has become the first-line therapy for infrapopliteal artery occlusive disease (IPOD), while the optimal endovascular method remains to be determined. We performed a network meta-analysis (NWM) of randomized controlled trials (RCTs) to simultaneously compare the outcomes of different endovascular modalities for IPOD.
METHODS AND RESULTS
The Pubmed, Embase, and Cochrane databases were used as data sources. The NWM approach used random-effects models based on the frequentist framework. In total, 22 eligible RCTs (44 study arms; 1,348 patients) involving nine endovascular modalities or combinations [balloon angioplasty (BA), drug-coated balloon (DCB), drug-eluting stent (DES), atherectomy device + BA (AD + BA), AD + DCB, balloon-expandable bare metal stent (BMS), self-expanding stent (SES), absorbable metal stents (AMS), and inorganics-coated stent (ICS)] were included. BA had a lower 12-month primary patency rate than DCB (RR 0.50, CI 0.27, 0.93) and AD + DCB (RR 0.34, CI 0.12, 0.93). AD + DCB decreased 6-month TLR compared with AMS (RR 0.15, CI 0.03, 0.90), and DES decreased it compared with BMS (RR 0.25, CI 0.09, 0.71). DCB had a lower 6-month TLR rate than AMS (RR 0.26, CI 0.08, 0.86) and BA (RR 0.51, CI 0.30, 0.89). BA had a higher 12-month TLR rate than DCB (RR 1.76, CI 1.07, 2.90). According to the value of the surface under the cumulative ranking curve (SUCRA), AD + DCB was considered the best treatment in terms of primary patency at 6 months (SUCRA = 87.5) and 12 months (SURCA = 91). AD + BA was considered the best treatment in terms of 6-month TLR (SUCRA = 83.1), 12-month TLR (SURCA = 75.8), and 12-month all-cause mortality (SUCRA = 92.5). In terms of 12-month major amputation, DES was considered the best treatment (SUCRA = 78.6), while AD + DCB was considered the worst treatment (SUCRA = 28.8). Moreover, AD + BA always ranks higher than AD + DCB in the comparison including these two combinations. Subgroup analyses of modalities without stenting did not significantly change the primary outcomes.
CONCLUSION
ADs showed noteworthy advantages in multiple terms for IPOD except for 12-month major amputation. AD + BA may be a better method for IPOD than AD + DCB. The efficacy and safety of ADs are worthy of further investigation.
SYSTEMATIC REVIEW REGISTRATION
[https://www.crd.york.ac.uk/prospero/], identifier [CRD42022331626].
PubMed: 36439998
DOI: 10.3389/fcvm.2022.993290 -
Journal of Vascular Surgery Jul 2020Our study aimed to perform a meta-analysis based on current evidence to investigate the efficacy of different debulking devices in the treatment of femoropopliteal... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Our study aimed to perform a meta-analysis based on current evidence to investigate the efficacy of different debulking devices in the treatment of femoropopliteal in-stent restenosis (FP-ISR).
METHODS
We systematically searched for articles reporting treatment of FP-ISR patients in the MEDLINE, Embase, and Cochrane databases. Randomized controlled trials, cohort studies, and retrospective studies were included, and clinical characteristic outcomes were extracted and pooled. The efficacy end points included primary patency and freedom from target lesion revascularization (TLR) at 1 year. Pooled estimates were calculated using the random effects model. For each point, effect size and 95% confidence intervals (CIs) were calculated.
RESULTS
We identified 12 studies with 743 patients that could be included in this meta-analysis. The overall primary patency at 1 year was 58.3% (95% CI, 44.7%-71.9%), and freedom from TLR at 1 year was 67.0% (95% CI, 60.5%-74.6%). Subgroup analysis showed that the laser debulking + percutaneous transluminal angioplasty (PTA) group was associated with a similar primary patency and freedom from TLR compared with the mechanical debulking + PTA group (53.8% vs 52.8; 65.4% vs 62.1%). Subgroup analysis demonstrated that the long lesion and short lesion groups and the occlusive and stenosis groups shared similar results of primary patency and freedom from TLR. Laser + drug-coated balloon was associated with higher primary patency and freedom from TLR compared with laser + PTA (78.5% vs 58.3%; 76.7% vs 66.4%).
CONCLUSIONS
Debulking devices show promising and favorable results for FP-ISR patients with complex lesions. Debulking devices combined with a drug-coated balloon might be an efficacious way to treat FP-ISR complex lesions in the future.
Topics: Angioplasty; Atherectomy; Femoral Artery; Humans; Laser Therapy; Peripheral Arterial Disease; Popliteal Artery; Recurrence; Risk Factors; Thrombectomy; Treatment Outcome; Vascular Patency
PubMed: 32093910
DOI: 10.1016/j.jvs.2019.11.058 -
Cardiovascular Revascularization... Apr 2020Percutaneous coronary intervention (PCI) outcomes for patients with significant calcification have been consistently inferior compared to patients without significant... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Percutaneous coronary intervention (PCI) outcomes for patients with significant calcification have been consistently inferior compared to patients without significant calcification. Procedural success and long-term outcomes after PCI have been worse in patients with severe coronary calcium.
OBJECTIVE
A Bayesian meta-analysis of outcomes comparing rotational atherectomy (RA) with orbital atherectomy (OA) was performed.
METHODS
PubMed, Embase, and Cochrane Library databases were searched through 30th November 2018 and identified 4 observational studies.
RESULTS
The primary end-point, Major Adverse Cardiac Event (MACE) composing of death, MI and stroke at 1 year was more likely with RA (OR = 1.61; 95% CI: 1.11-2.33; p = 0.01) as compared to OA. The driver of the difference in MACE between the two groups was a statistically significant difference in mortality favoring OA (OR = 4.65; 95% CI: 1.36-15.87; p = 0.01). Peri-procedural MI, the other component of the primary end-point was 1.3 times more likely in the RA arm (OR = 1.35; 95% CI 0.95-1.92; p-0.09) and was not statistically different between the groups. The odds of a vascular complication were not different in the two groups (OR = 1.26; 95% CI: 0.73-2.17; p = 0.41). In an adjusted Bayesian analysis, mortality (OR = 3.69; 95% CI: 0.30-38.51), MACE (OR = 1.68; 95% CI: 0.55-5.49), MI (OR = 1.42; 95% CI: 0.50-4.29) and dissections/perforations (OR = 0.38; 95% CI: 0.10-1.38) were not different in RA and OA groups.
CONCLUSION
Our study is the first published Bayesian meta-analysis comparing MACE and peri-procedural outcomes in RA compared to OA. These findings lay the foundation for a randomized comparison between the two competing technologies.
Topics: Atherectomy, Coronary; Bayes Theorem; Coronary Artery Disease; Humans; Percutaneous Coronary Intervention; Risk Factors; Severity of Illness Index; Treatment Outcome; Vascular Calcification
PubMed: 31377129
DOI: 10.1016/j.carrev.2019.07.019 -
Cardiovascular Revascularization... Jun 2024
Meta-Analysis
Topics: Humans; Atherectomy, Coronary; Lithotripsy; Vascular Calcification; Coronary Artery Disease; Treatment Outcome; Risk Factors; Male; Aged; Female
PubMed: 38307793
DOI: 10.1016/j.carrev.2024.01.012 -
Journal of Endovascular Therapy : An... Aug 2020Endovascular revascularization has been increasingly utilized to treat patients with chronic limb-threatening ischemia (CLTI), particularly atherosclerotic disease in...
Endovascular revascularization has been increasingly utilized to treat patients with chronic limb-threatening ischemia (CLTI), particularly atherosclerotic disease in the infrapopliteal arteries. Lesions of the infrapopliteal arteries are the result of 2 different etiologies: medial calcification and intimal atheromatous plaque. Although several devices are available for endovascular treatment of infrapopliteal lesions, balloon angioplasty still comprises the mainstay of therapy due to a lack of purpose-built devices. The mechanism of balloon angioplasty consists of adventitial stretching, medial necrosis, and dissection or plaque fracture. In many cases, the diffuse nature of infrapopliteal disease and plaque complexity may lead to dissection, recoil, and early restenosis. Optimal balloon angioplasty requires careful attention to assessment of vessel calcification, appropriate vessel sizing, and the use of long balloons with prolonged inflation times, as outlined in a treatment algorithm based on this systematic review. Further development of specific devices for this arterial segment are warranted, including devices for preventing recoil (eg, dedicated atherectomy devices), treating dissections (eg, tacks, stents), and preventing neointimal hyperplasia (eg, novel drug delivery techniques and drug-eluting stents). Further understanding of infrapopliteal disease, along with the development of new technologies, will help optimize the durability of endovascular interventions and ultimately improve the limb-related outcomes of patients with CLTI.
Topics: Algorithms; Amputation, Surgical; Angioplasty, Balloon; Chronic Disease; Clinical Decision-Making; Decision Support Techniques; Humans; Ischemia; Limb Salvage; Patient Selection; Peripheral Arterial Disease; Popliteal Artery; Recurrence; Risk Factors; Treatment Outcome; Vascular Patency
PubMed: 32571125
DOI: 10.1177/1526602820931488 -
Catheterization and Cardiovascular... Dec 2020This review aims to evaluate the adverse outcomes for patients after treatment with covered stents.
OBJECTIVES
This review aims to evaluate the adverse outcomes for patients after treatment with covered stents.
BACKGROUND
Coronary perforation is a potentially fatal complication of percutaneous coronary revascularization which may be treated using covered stents. Studies have evaluated long-term outcomes among patients who received these devices, but hitherto no literature review has taken place.
METHODS
We conducted a systematic review of adverse outcomes for patients after treatment with covered stents. Data from studies were pooled and outcomes were compared according to stent type.
RESULTS
A total of 29 studies were analyzed with data from 725 patients who received covered stents. The proportion of patients with chronic total occlusions, vein graft percutaneous coronary intervention (PCI), intracoronary imaging and rotational atherectomy were 16.9, 11.5, 9.2, and 6.6%, respectively. The stents used were primarily polytetrafluoroethylene (PTFE) (70%) and Papyrus (20.6%). Mortality, major adverse cardiovascular events, pericardiocentesis/tamponade and emergency surgery were 17.2, 35.3, 27.1, and 5.3%, respectively. Stratified analysis by use of PTFE, Papyrus and pericardial stents, suggested no difference in mortality (p = .323), or target lesion revascularization (p = .484). Stent thrombosis, pericardiocentesis/tamponade and emergency coronary artery bypass surgery (CABG) occurred more frequently in patients with PTFE stent use (p = .011, p = .005, p = .012, respectively). In-stent restenosis was more common with pericardial stent use (<.001, pooled analysis for first- and second-generation pericardial stents).
CONCLUSIONS
Cases of coronary perforation which require implantation of a covered stent are associated with a high rate of adverse outcomes. The use of PTFE covered stents appears to be associated with more stent thrombosis, pericardiocentesis/tamponade, and emergency CABG when compared to Papyrus or pericardial stents.
Topics: Adult; Aged; Aged, 80 and over; Coronary Vessels; Female; Heart Injuries; Hemostatic Techniques; Humans; Male; Middle Aged; Percutaneous Coronary Intervention; Prosthesis Design; Risk Assessment; Risk Factors; Stents; Treatment Outcome; Vascular System Injuries
PubMed: 31850685
DOI: 10.1002/ccd.28646 -
Annals of Vascular Surgery Jul 2024This Bayesian network meta-analysis (NMA) sought to evaluate the efficacy of different endovascular treatments for femoropopliteal artery in-stent restenosis (FP-ISR). (Meta-Analysis)
Meta-Analysis
BACKGROUND
This Bayesian network meta-analysis (NMA) sought to evaluate the efficacy of different endovascular treatments for femoropopliteal artery in-stent restenosis (FP-ISR).
METHODS
PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of science for clinical trials from database inception to March 31, 2023, with no language restrictions to retrieve randomized controlled trials or cohort studies evaluating the impact of any kind of endovascular treatments for FP-ISR. Pair-wise meta-analysis and Bayesian NMA were performed to pool the outcome estimates different endovascular treatments. The primary end points under consideration were primary patency rates at both 6-month and 12-month follow-up.
RESULTS
A total of 15 studies with 1,424 patients were ultimately enrolled to be analyzed, 7 types of endovascular treatment were identified for comparison. In terms of primary patency and freedom from target lesion revascularization (TLR) at 6-month and12-month follow-up, the direct meta-analysis findings showed that drug-coated balloons (DCB) and covered stent (CS) are considerably superior to plain old balloon angioplasty (POBA), Excimer laser atherectomy (ELA) + DCB is significantly better than DCB. According to the meta-analysis based on Bayesian theory, during the 6-month and 12-months follow-up, we could not find significant difference between the different treatments in terms of the primary patency and the freedom from TLR, based on the surface values under the cumulative ranking curve (SUCRA), CS was considered the best treatment in terms of primary patency (6 months SUCRA = 85.2; 12 months SUCRA = 78.9) and freedom from TLR (6 months SUCRA = 84.9; 12 months SUCRA = 70.9); directional atherectomy + POBA may lead to higher survival rate at 12 months (SUCRA = 89.1) than others treatments; in addition, both ELA + POBA and ELA + DCB have higher limb salvage than POBA.
CONCLUSIONS
The findings of this NMA suggest that CS showed positive encouraging results in primary patency and TLR in FP-ISR at 6 and 12 months. However, due to the potential influence of certain confounding factors, the long-term results necessitate validation through numerous randomized controlled trials.
Topics: Aged; Female; Humans; Male; Middle Aged; Angioplasty, Balloon; Bayes Theorem; Coated Materials, Biocompatible; Endovascular Procedures; Femoral Artery; Network Meta-Analysis; Peripheral Arterial Disease; Popliteal Artery; Recurrence; Risk Factors; Stents; Time Factors; Treatment Outcome; Vascular Patency
PubMed: 38492725
DOI: 10.1016/j.avsg.2023.12.081