Lukacs Reka Aliz, Weisshaar Lisa Ingrid, Tornyos Daniel, Komocsi Andras
Department of Interventional Cardiology, Heart Institute, Medical School, University of Pécs, 7624 Pécs, Hungary.
Klinikum Leverkusen Medical Clinic 1, 51375 Leverkusen, Germany.
J Clin Med. 2024 Feb 10;13(4):1024. doi: 10.3390/jcm13041024.
Endovascular therapy offers an alternative for treating femoropopliteal (FP) and infrapopliteal (IP) lesions related to occlusive lower extremity artery disease. Despite numerous trials, the effectiveness of restenosis prevention using local drug delivery devices remains a topic of debate.
An updated systematic review and network meta-analysis was conducted. Our overall aim was to summarize the most recent clinical evidence regarding endovascular approaches for FP and IP atherosclerotic lesions.
We conducted a search for randomized trials in the MEDLINE database, and extracted data related to clinical endpoints. Our primary focus was on the rate of major adverse events (MAEs), including mortality, amputation, and target lesion revascularization (TLR). A multiple treatment network meta-analysis supplemented with component network analyses was performed to examine the impact of combined treatment.
Our search yielded 33 randomized controlled trials encompassing 5766 patients. This included 19 studies focused on femoropopliteal and 14 on IP lesions, accounting for 3565 and 2201 patients, respectively. Drug-coated balloons (DCBs) and drug-eluting stents (DESs) displayed a reduced MAE risk in comparison to plain old balloon angioplasty (POBA)-RR for DCB: 0.64 (95% CI: 0.52-0.77) and for DES: 0.71 (95% CI: 0.51-0.99). The bare-metal stent (BMS) group manifested the most substantial MAE risk, being 59% higher relative to the DCB cohort (BMS vs. DCB RR: 1.59; 95% CI: 1.03-2.47). For FP lesions, DES was the standout performer, curtailing MAE risk by 55% relative to POBA. Within IP lesions, DES mitigated the MAE risk by 25% versus POBA. DCB did not exhibit any notable MAE reduction when pitted against POBA.
In FP arteries, both DESs and DCBs yielded significantly diminished MAEs, thus outpacing other techniques. Regarding IP arteries, only DESs resulted in significantly fewer MAEs. In alignment with contemporary research, our findings revealed no signs of elevated mortality in patients undergoing treatment with drug-eluting apparatuses.
血管内治疗为治疗与下肢动脉闭塞性疾病相关的股腘（FP）和腘下（IP）病变提供了一种替代方法。尽管进行了大量试验，但使用局部药物递送装置预防再狭窄的有效性仍是一个有争议的话题。
进行了一项更新的系统评价和网状荟萃分析。我们的总体目标是总结关于FP和IP动脉粥样硬化病变血管内治疗方法的最新临床证据。
我们在MEDLINE数据库中检索随机试验，并提取与临床终点相关的数据。我们主要关注主要不良事件（MAE）发生率，包括死亡率、截肢率和靶病变血运重建（TLR）。进行了一项多重治疗网状荟萃分析，并辅以成分网络分析，以检验联合治疗的影响。
我们的检索产生了33项随机对照试验，涉及5766名患者。其中包括19项针对股腘病变的研究和14项针对腘下病变的研究，分别涉及3565名和2201名患者。与普通球囊血管成形术（POBA）相比，药物涂层球囊（DCB）和药物洗脱支架（DES）显示出MAE风险降低——DCB的风险比（RR）为0.64（95%置信区间：0.52 - 0.77），DES的RR为0.71（95%置信区间：0.51 - 0.99）。裸金属支架（BMS）组表现出最高的MAE风险，相对于DCB队列高出59%（BMS与DCB的RR：1.59；95%置信区间：1.03 - 2.47）。对于股腘病变，DES表现突出，相对于POBA将MAE风险降低了55%。在腘下病变中，DES相对于POBA将MAE风险降低了25%。与POBA相比，DCB未显示出MAE有任何显著降低。
在股腘动脉中，DES和DCB均显著降低了MAE，因此优于其他技术。对于腘下动脉，只有DES导致MAE显著减少。与当代研究一致，我们的研究结果显示接受药物洗脱器械治疗的患者没有死亡率升高的迹象。
