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

Christos Kasapis, Peter K. Henke, Stanley J. Chetcuti, Gerald C. Koenig, John E. Rectenwald, Venkataramu N. Krishnamurthy, Paul Michael Grossman, Hitinder S. Gurm

Research output: Contribution to journalArticlepeer-review

89 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)44-55
Number of pages12
JournalEuropean heart journal
Volume30
Issue number1
DOIs
StatePublished - Jan 2009

Keywords

  • Angioplasty
  • Balloon
  • Meta-analysis
  • Peripheral vascular disease
  • Stents

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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