-
European Journal of Vascular and... Mar 2024Biomimetic stents are peripheral infrainguinal self expanding stents that mimic the anatomy of the vasculature and artery movement. They are indicated for use in... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Biomimetic stents are peripheral infrainguinal self expanding stents that mimic the anatomy of the vasculature and artery movement. They are indicated for use in infrainguinal arteries. This research aimed to synthesise all current evidence on the use of biomimetic stents as adjuncts for endovascular treatment of infrainguinal peripheral arterial disease (PAD), helping to guide clinical decision making.
DATA SOURCES
MEDLINE, Embase, CINAHL and Cochrane databases.
REVIEW METHODS
Random effects meta-analysis following PRISMA guidelines (PROSPERO registration CRD42022385256). Study quality was assessed using the Joanna Briggs Institute critical appraisal tools checklist, and certainty assessment through the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Endpoints included primary patency, target lesion revascularisation, stent fracture, secondary patency, and Death at one year.
RESULTS
In total, 37 studies were included in the meta-analysis (33 cohort studies, two case series, and two randomised controlled trials [RCTs]), representing 4 480 participants. Of these, 34 studies included data on the Supera (81.5% of participants) and three studies reported data on the BioMimics 3D (18.5% of participants) stents. The pooled primary patency rate of 33 studies at one year follow up was 81.4% (95% confidence interval [CI] 78.7 - 83.9%), and the pooled target lesion revascularisation rate of 18 studies at one year was 12.2% (95% CI 9.6 - 15.0%). The certainty of evidence outcome rating as qualified by GRADE was very low for both. Only one study reported a positive stent fracture rate at one year follow up of 0.4% with a certainty of evidence outcome of low.
CONCLUSION
Using biomimetic stents for infrainguinal PAD may be associated with acceptable one year primary patency and target lesion revascularisation rates, with a near negligible one year stent fracture rate. Their use should be considered in those presenting with infrainguinal PAD undergoing endovascular revascularisation. A RCT is necessary to determine their clinical and cost effectiveness.
Topics: Humans; Biomimetics; Endovascular Procedures; Peripheral Arterial Disease; Stents; Treatment Outcome; Vascular Patency
PubMed: 37931680
DOI: 10.1016/j.ejvs.2023.11.007 -
Open Access Emergency Medicine : OAEM 2023Heatstroke (HS) is a severe form of heat-related illness (HRI) associated with high morbidity and mortality, representing a condition that includes long-term multiorgan...
INTRODUCTION
Heatstroke (HS) is a severe form of heat-related illness (HRI) associated with high morbidity and mortality, representing a condition that includes long-term multiorgan dysfunction and susceptibility to further heat illness.
METHODS
In a systematic review searching Medline PubMed from the studies conducted between 2009 and 2020, 16 papers were identified.
RESULTS
A hallmark symptom of heat stroke is CNS dysfunction (a hallmark sign of HS) which manifests as mental status changes, including agitation, delirium, epilepsy, or coma at the time of the collapse. Acute kidney injury (AKI), gut ischemia, blood clots in the stomach and small intestine, cytoplasmic protein clumps in the spleen, and injury of skeletal muscle (rhabdomyolysis) are all characteristics of peripheral tissue damage. Severe heat stroke tends to be complicated by rhabdomyolysis, especially in patients with exertional heat stroke. Rhabdomyolysis may lead to systemic effects, including the local occurrence of compartment syndrome, hyperkalemic cardiac arrest, and/or lethal disseminated intravascular coagulopathy. Untreated heat stroke might exacerbate psychosis, lactic acidosis, consumptive coagulopathy, hematuria, pulmonary edema, renal failure, and other metabolic abnormalities. Core body temperature and level of consciousness are the most significant indicators to diagnose the severity of heat stroke and prevent unfavorable consequences. Heatstroke is a life-threatening illness if not promptly recognized and effectively treated.
DISCUSSION
This review highlighted that core body temperature and white blood cell count are significant contributing factors affecting heat stroke outcomes. Other factors contributing to the poor outcome include old age, low GCS, and prolonged hospital stay. The prevalence of both classic and exertional heatstroke can be reduced by certain simple preventive measures, such as avoiding strenuous activity in hot environments and reducing exposure to heat stress.
PubMed: 37771523
DOI: 10.2147/OAEM.S419028 -
International Journal of Surgery... Dec 2023Critical limb-threatening ischaemia is a life-threatening disease which often combines with infrapopliteal arterial disease. Percutaneous transluminal angioplasty (PTA)... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Critical limb-threatening ischaemia is a life-threatening disease which often combines with infrapopliteal arterial disease. Percutaneous transluminal angioplasty (PTA) is recommended as the first-line treatment for infrapopliteal arterial disease. Drug-eluting stent (DES) is another widely used option; however, its long-term therapeutic effect is controversial. The effectiveness of different DES for infrapopliteal arterial disease needs further exploration.
METHODS AND RESULTS
The PubMed, EMBASE, Cochrane Library and Clinical trials were systematically searched from inception to 1 February 2023. Literatures were included if the study was original, peer-reviewed, published in English or Chinese, and contained patients diagnosed with simple infrapopliteal arterial disease or with properly treated combined inflow tract lesions before or during the study procedure. A total of 953 patients, 504 in the DES group and 449 in the PTA/bare-metal stenting (BMS) group, from 12 randomised controlled trials were included in the meta-analysis. The results showed that DES is superior to control group for improving clinical patency, reducing the restenosis rate, and reducing the amputation rate at 6 months, 1 year, and 3 years post-treatment [at 3 years, risk ratio (RR): 1.90, 95% CI 1.23-2.93; RR: 0.87, 95% CI 0.79-0.96; RR: 0.60, 95% CI 0.36-1.00, P =0.049]. In addition, subgroup analyses suggested that DES is superior to BMS and PTA in improving clinical patency and reducing target lesion revascularisation and restenosis rates at 6-month and 1-year post-treatment. The network meta-analysis indicated that sirolimus-eluting stent was superior for improving clinical patency (at 1 year, RR: 0.23, 95% CI 0.08-0.60) and reducing the restenosis rate (at 6 months, RR: 31.58, 95% CI 4.41-307.53, at 1 year, RR: 3.80, 95% CI 1.84-8.87) significantly. However, according to the cumulative rank probabilities test, everolimus-eluting stent may have the lowest target lesion revascularisation rates and amputation rates at 1-year post-treatment (the cumulative rank probability was 77% and 49%, respectively).
CONCLUSIONS
This systematic review and network meta-analysis showed that DES was associated with more clinical efficacy than PTA/BMS significantly. In addition, sirolimus-eluting stent and everolimus-eluting stent may have better clinical benefits.
Topics: Humans; Bayes Theorem; Drug-Eluting Stents; Everolimus; Peripheral Arterial Disease; Popliteal Artery; Sirolimus; Stents; Treatment Outcome
PubMed: 37720942
DOI: 10.1097/JS9.0000000000000736 -
Nutrition, Metabolism, and... Aug 2023The Controlling Nutritional Status (CONUT) score is a tool for assessing the risk of malnutrition (undernutrition) that can be calculated from albumin concentration,... (Meta-Analysis)
Meta-Analysis
AIMS
The Controlling Nutritional Status (CONUT) score is a tool for assessing the risk of malnutrition (undernutrition) that can be calculated from albumin concentration, total peripheral lymphocyte count, and total cholesterol concentration. CONUT score has been proposed as a promising prognostic marker in several clinical settings; however, a consensus on its prognostic value in patients with stroke is lacking. The aim of this systematic review and meta-analysis was to evaluate the relationship between CONUT score and clinical outcomes in patients with stroke based on all current available studies.
DATA SYNTHESIS
Systematic research on PubMed, Scopus and Web of Science from inception to February 2023 was performed on the association between CONUT score and clinical outcomes in patients with stroke. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. Methodological quality was evaluated using the Newcastle-Ottawa Scale quality assessment tool. Pooled effect estimation was calculated by a random-effect model. Through the initial literature search, 15 studies (all high-quality) including 16 929 patients were found to be eligible and analysed in the meta-analysis. A significant risk of malnutrition (in most studies defined by a CONUT score ≥5) was directly associated with mortality, higher risk of poor functional outcome according to the modified Rankin Scale and total infection development. Evidence was consistent for acute ischaemic stroke and preliminary for acute haemorrhagic stroke.
CONCLUSION
CONUT score is an independent prognostic indicator, and it is associated with major disability and infection development during hospitalisation.
PROSPERO ID
CRD42022306560.
Topics: Humans; Nutritional Status; Brain Ischemia; Stroke; Malnutrition; Prognosis; Retrospective Studies; Nutrition Assessment
PubMed: 37336716
DOI: 10.1016/j.numecd.2023.05.012 -
Journal of Endovascular Therapy : An... Apr 2024Infrapopliteal lesions are generally complex to treat due to small vessel diameter, long lesion length, multilevel disease, and severe calcification. Therefore,... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Infrapopliteal lesions are generally complex to treat due to small vessel diameter, long lesion length, multilevel disease, and severe calcification. Therefore, different vessel preparation devices have been developed to contribute to better peri- and postprocedural outcomes. This systematic review aims to compare different vessel preparation techniques prior to plain old balloon angioplasty (POBA) or drug-coated balloon (DCB) angioplasty with POBA or DCB alone in infrapopliteal arterial disease.
METHODS
Medline, EMBASE, and Cochrane databases were searched for studies published between 2000 and 2022 assessing the value of adjunctive vessel preparation in infrapopliteal arterial disease. The primary outcomes were 12-month primary patency and limb salvage.
RESULTS
A total of 1685 patients with 1913 lesions were included in 11 POBA studies. Methodological quality was assessed as poor to moderate in these studies. Only 2 studies with 144 patients assessed vessel preparation in conjunction with DCB angioplasty. These randomized trials were assessed as high quality and found no significant benefit of adjunctive atherectomy to DCB angioplasty. The pooled Kaplan-Meier estimates of 12-month primary patency and limb salvage in the POBA studies were 67.8% and 80.9% for POBA, 62.1% and 86.4% for scoring balloons, 67.9% and 79.6% for mechanical atherectomy (MA), and 79.7% and 82.6% for laser atherectomy, respectively. Within the pooled data only scoring balloons and MA demonstrated significantly improved 12-month limb salvage compared to POBA.
CONCLUSIONS
Different forms of adjunctive vessel preparation demonstrate similar 12-month outcomes compared to POBA and DCB angioplasty alone in infrapopliteal disease, with the exception of improved 12-month limb salvage in scoring balloons and MA. However, since the included studies were heterogeneous and assessed as poor to moderate methodological quality, selection bias may have played an important role. Main conclusion is that this systematic review found no additional value of standard use of vessel preparation.
CLINICAL IMPACT
Infrapopliteal arterial disease is associated with chronic limb-threatening ischemia (CLTI) and generally complex to treat due to small vessel diameter, long lesion length, multilevel disease and severe calcification. A wide range of vessel preparation devices have been developed to contribute to improved peri- and postprocedural outcomes in these complex lesions. This systematic review aims to compare different vessel preparation techniques prior to plain old balloon angioplasty (POBA) or drug coated balloon (DCB) angioplasty with POBA or DCB angioplasty alone in infrapopliteal arterial disease. Different forms of adjunctive vessel preparation demonstrate similar 12-month outcomes compared to POBA and DCB angioplasty alone in infrapopliteal disease, with the exception of improved 12-month limb salvage in scoring balloons and mechanical atherectomy (MA). However, since the included studies were heterogeneous and assessed as poor to moderate methodological quality, selection bias may have played an important role. Main conclusion is that this systematic review found no additional value of standard use of vessel preparation.
Topics: Humans; Femoral Artery; Popliteal Artery; Peripheral Arterial Disease; Risk Factors; Treatment Outcome; Angioplasty, Balloon; Coated Materials, Biocompatible; Vascular Patency
PubMed: 36062761
DOI: 10.1177/15266028221120752