Meta-Analysis of Drug-Eluting Balloon Angioplasty and Drug-Eluting Stent placement shows Superior Outcomes compared to PTA and BMS

A multi-institutional team recently published a met-analysis of RCTs of DEB and DES for infrainguinal peripheral arterial disease. Baerlocher et al identified 8 RCTs for DEB (763 unique patients) and 12 RCTs for DES (1,228 unique patients). Individual study bias was assessed by using the Cochrane risk for bias tool and the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) methodology was used to rate the confidence in each reported outcome as high, moderate, low, or very low. The results were expressed as averages of the given outcome per individual patient, effect sizes were expressed by Hedges g, and ORs were calculated in cases in which proportions or rates were used. The results indicate a statistically significant benefit of DEB angioplasty and DES placement in the treatment of femoral-popliteal and/or infrapopliteal arterial disease restenosis and target lesion revascularization. There was no benefit in major amputation or mortality.

Comment:

While the present study yielded similar results to other meta-analyses covering the same topic, the study is noteworthy for its inclusion of the most recent literature, use of the GRADE methodology, and data inclusion methods. Further, the study evaluated a larger vascular territory when compared with previous studies. However, while a reflection of the RCTs included in the meta-analysis, there remains a significant amount of heterogeneity within the lesions treated (eg length, amount of calcification, location, etc). Further, long-term follow-up data, cost/benefit analysis, and a defined lesion-based treatment algorithm remain areas for future research.


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Risk of bias across studies assessing DEB angioplasty outcomes. The x axis represents percentage of studies.

Risk of bias across studies assessing DES placement outcomes. The x axis represents percentage of studies.


Citation: Baerlocher, M. O. et al. Meta-Analysis of Drug-Eluting Balloon Angioplasty and Drug-Eluting Stent Placement for Infrainguinal Peripheral Arterial Disease. Journal of Vascular and Interventional Radiology 26, 459–473.e4 (2015).


Post author: Luke Wilkins, MD