European Heart Journal Advance Access originally published online on November 21, 2008
European Heart Journal 2009 30(1):44-55; doi:10.1093/eurheartj/ehn514
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Routine stent implantation vs. percutaneous transluminal angioplasty in femoropopliteal artery disease: a meta-analysis of randomized controlled trials
1 Division of Cardiovascular Medicine, University of Michigan Health System, TC B1 226, 2A394, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5853, USA
2 Division of Vascular Surgery, University of Michigan, Ann Arbor, MI, USA
3 Division of Radiology, University of Michigan, Ann Arbor, MI, USA
Received 14 April 2008; revised 20 September 2008; accepted 23 October 2008; online publish-ahead-of-print 21 November 2008.
* Corresponding author. Tel: +1 734 232 4276, Fax: +1 734 764 4142, Email: hgurm{at}med.umich.edu
Aims: We performed a meta-analysis of randomized controlled trials comparing routine stenting (ST) with percutaneous transluminal angioplasty (PTA) for symptomatic superficial femoral-popliteal artery (SFPA) disease.
Methods and results: Ten trials were pooled randomizing patients to ST (n = 724 limbs) or PTA with provisional stenting (n = 718 limbs) with a follow-up period of 9–24 months. The mean lesion length was similar in the two groups (45.8 mm in the ST group and 43.3 mm in the PTA group). We calculated the summary risk ratios (RRs) for immediate technical failure, restenosis, and target vessel revascularization (TVR) using random-effects models. The immediate technical failure was higher in the PTA group than in the ST group [17.1 vs. 5.9%, respectively, RR = 0.28, 95% confidence interval (CI) = 0.15–0.54, P < 0.001], with 10.3% of the PTA patients undergoing stenting because of suboptimal result. There was a trend for lower restenosis in the ST group (37.6% in ST vs. 45.3% in PTA, RR = 0.85, 95% CI = 0.69–1.06, P = 0.146), but no difference in the need for TVR (20% in ST vs. 20.2% in PTA, RR = 0.98, 95% CI = 0.78–1.23, P = 0.89). In an analysis restricted to nitinol stents, there was a trend towards reduction in TVR (RR = 0.79, 95% CI = 0.59–1.06, P = 0.12).
Conclusion: Despite the higher immediate success, routine stenting was not associated with a significant reduction in the rate of restenosis or TVR. Our data do not support use of routine stenting as the primary endovascular treatment for short SFPA lesions.
Key Words: Peripheral vascular disease • Meta-analysis • Balloon • Angioplasty • Stents
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C. Kasapis and H. S. Gurm Routine stent implantation vs. percutaneous transluminal angioplasty in femoropopliteal artery disease: a meta-analysis of randomized controlled trials: reply Eur. Heart J., October 31, 2009; (2009) ehp467v1. [Full Text] [PDF]
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