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Infragenicular Stent Implantation for Below-the-Knee Atherosclerotic Disease: Clinical Evidence from an International Collaborative Meta-Analysis on 640 Patients
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Infragenicular Stent Implantation for Below-the-Knee Atherosclerotic Disease: Clinical Evidence from an International Collaborative Meta-Analysis on 640 Patients
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Journal Article
Infragenicular Stent Implantation for Below-the-Knee Atherosclerotic Disease: Clinical Evidence from an International Collaborative Meta-Analysis on 640 Patients
2009
Overview
Purpose:
To report a systematic review of the literature published on the outcomes of
stenting for below-the-knee disease in patients with critical limb ischemia
(CLI).
Methods:
Potentially relevant studies of stent implantation in the infragenicular
arteries in ≥5 patients with ≥1-month follow-up were
systematically sought in BioMedCentral, ClinicalTrials.gov, The Cochrane
Collaboration Register of Controlled Trials (CENTRAL), Google Scholar, and
PubMed. Data were abstracted and pooled with a random-effect model to
generate risk estimates with 95% confidence intervals (CI).
Interaction tests were performed to compare different stent types. A risk of
bias assessment was conducted separately, as were appraisals for small study
bias, statistical heterogeneity, and inconsistency.
Results:
Eighteen nonrandomized studies were retrieved comprising 640 patients. After
a median follow-up of 12 months, binary in-stent restenosis occurred in
25.7% (95% CI 11.6% to 40.0%), primary patency
in 78.9% (95% CI 71.8% to 86.0%), improvement in
Rutherford class in 91.3% (95% CI 85.5% to
97.1%), target vessel revascularization in 10.1% (95%
CI 6.2% to 13.9%), and limb salvage in 96.4%
(95% CI 94.7% to 98.1%). Head-to-head comparisons
showed that sirolimus-eluting stents were superior to balloon-expandable
bare metal stents in preventing restenosis and increasing primary patency
(both p<0.001); sirolimus-eluting stents were also better than
paclitaxel-eluting stents in terms of primary patency (p<0.001) and
repeat revascularizations (p=0.014).
Conclusion:
Percutaneous infragenicular stent implantation after failed or unsuccessful
balloon angioplasty is associated with favorable clinical results in
patients with CLI. Notwithstanding limitations of primary studies,
sirolimus-eluting stents appear superior to bare metal and
paclitaxel-eluting stents in terms of angiographic and/or clinical
outcomes.
Publisher
SAGE Publications,Allen Press Inc
Subject
