Published online Aug 6, 2023. doi: 10.12998/wjcc.v11.i22.5273
Peer-review started: May 5, 2023
First decision: July 3, 2023
Revised: July 7, 2023
Accepted: July 17, 2023
Article in press: July 17, 2023
Published online: August 6, 2023
Processing time: 90 Days and 3.4 Hours
Whether accompanied with femoropopliteal inflow disease or not, infrapopliteal artery disease (IPAD) is the primary cause of critical limb ischemia. In the past few decades, minimally invasive percutaneous transluminal angioplasty (PTA) with or without bare metal stent implantation (BMSI) has been widely used.
However, although this treatment has satisfactory technical success rate, it still has a significantly high risk of clinical failure caused by lesion restenosis even in the short term.
In order to more accurately evaluate the efficacy of drug-eluting stents (DES) implantation for IPADs, we performed this systematic review and meta-analysis.
After extensive retrieval of major databases, the hazard ratio (HR) is used as the outcome measure for extraction or conversion, and the meta analyses for multiple outcomes of interest were performed.
Five randomized controlled trials and three cohort studies involving 2639 participants totally were included. Compared with the control arm (PTA and BMSI), the HR values of the DES implantation on all- cause death -free survival and major amputation -free survival were not statistically significant (P > 0.05), but the HR values on target lesion revascularization -free survival, adverse event -free survival, and primary patency -survival were 2.65 (95%CI: 1.56-4.50), 1.57 (95%CI: 1.23-2.01), and 5.67 (95%CI: 3.56-9.03), respectively.
In our conclusion, DES is a good option for IPADs to maintain efficacy for a long time.
DES is a highly anticipated therapeutic device. We believe that there will be more and more randomized controlled trials about its application for IPADs in the future.