Routine stent implantation vs. percutaneous transluminal angioplasty in femoropopliteal artery disease: a meta-analysis of randomized controlled trials

• Published in: European heart journal Vol. 30; no. 1; pp. 44 - 55
• Main Authors: Kasapis, Christos, Henke, Peter K., Chetcuti, Stanley J., Koenig, Gerald C., Rectenwald, John E., Krishnamurthy, Venkataramu N., Grossman, Paul Michael, Gurm, Hitinder S.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-01-2009; Oxford Publishing Limited (England)
• Subjects: Aged; Angioplasty; Angioplasty, Balloon; Balloon; Biological and medical sciences; Blood Vessel Prosthesis Implantation; Cardiology. Vascular system; Diseases of the cardiovascular system; Female; Femoral Artery; Follow-Up Studies; Humans; Male; Medical sciences; Meta-analysis; Middle Aged; Peripheral vascular disease; Peripheral Vascular Diseases - surgery; Peripheral Vascular Diseases - therapy; Popliteal Artery; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Randomized Controlled Trials as Topic; Recurrence; Risk; Stents; Treatment Outcome; Peripheral vascular disease; Balloon; Angioplasty; Stents; Meta-analysis; Endoprosthesis; Disease; Instrumentation therapy; Cardiovascular disease; Implantation; Instrumental dilatation; Stent; Artery; Metaanalysis; Percutaneous route; Vascular disease; Randomization; Clinical trial; Femoropopliteal; Circulatory system; Cardiology; Comparative study
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehn514

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.