Meta-Analysis of Infrapopliteal Atherosclerotic Disease Treatment Shows Added Benefit with Drug-Eluting Stent Placement

There have been many advances in the treatment of critical limb ischemia, however, optimal management and factors affecting short and long-term procedural success have not been clearly elucidated. The authors performed a meta-analysis of 42 studies representing 3,660 unique patients. While the analysis focused primarily on short-term outcomes with a very heterogenous set of procedural and research methodologies, the manuscript found significant, device-dependent, differences. Technical success rates were higher with bare metal stents and drug-eluting stents than with atherectomy or percutaneous transluminal angioplasty. Further, DES use had higher primary patency rates than atherectomy, BMS, and PTA. In addition, the 30-day rate of TLR was significantly higher with PTA (8.1%) than with BMSs (2.2%; P < .05) and DESs (1.1%; P < .05).

Comments: 

While this study is limited due to a variety of factors, the analysis was surprising in the significant, device-dependent, differences that could be identified. While further research is necessary, the results support the use of DES in the setting of infrapopliteal disease to improve technical success, primary patency, and TLR rates.


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Artist rendition of a drug-eluting stent, reproduced via Vankatesh et al: http://www.slideshare.net/quizzito/bioabsorbable-drugeluting-cardiac-stent-analysis


Citation: Razavi MK, Mustapha JA, Miller LE. Contemporary Systematic Review and Meta-Analysis of Early Outcomes with Percutaneous Treatment for Infrapopliteal Atherosclerotic Disease. J Vasc Interv Radiol, 25 (2014) 1489-96.


Post author: Luke Wilkins, MD