Drug-delivering endovascular treatment versus angioplasty in artery occlusion diseases: a systematic review and meta-analysis

Abstract

Objective: The best management of patients with femoropopliteal and infrapopliteal artery occlusion disease is not clear. This study aimed to compare the efficacy of drug-coated balloons (DCBs) and drug-eluting stents (DESs) with percutaneous transluminal angioplasty (PTA) in patients with femoropopliteal or infrapopliteal arterial occlusive disease.

Methods: Medline, Cochrane, Embase, and Google Scholar databases were searched for randomized controlled trials from 1 January 2000 until 30 June 2016.

Results: Compared with PTA, significant benefits in favor of DCB and DES were found for target lesion revascularization (TLR) (OR = 0.38, 95% CI = 0.22 to 0.66, p = .001 for DCB; OR = 0.51, 95% CI = 0.32 to 0.81, p < .001 for DES). Primary patency rate was greater with DCB (p = .001) and DES (p < .001) than PTA. Compared with PTA, a significant reduction in mortality was observed in the DCB group (p = .039) but not in the DES group. Subgroup analysis found a lower rate of TLR and a higher rate of primary patency in the active group (DCB and DES) compared with the control group (PTA) in patients with femoropopliteal arterial occlusion (p ≤ .016) but not in patients with infrapopliteal arterial occlusion (p ≥ .063). Mortality was similar between active replacement and control groups both in the femoropopliteal arterial occlusion and the infrapopliteal arterial occlusion subgroups (all p > .05).

Conclusions: Significantly better TLR and primary patency rate were found in the drug-delivering endovascular treatments compared with the PTA group for patients with femoropopliteal arterial occlusion but not for patients with infrapopliteal arterial occlusion.

Keywords:

• Drug-eluting stent
• drug-coated balloon
• angioplasty
• peripheral arterial disease
• popliteal artery
• femoral artery
• paclitaxel

Transparency

Declaration of funding

This manuscript was not funded.

Author contributions: X.C.: guarantor of integrity of the entire study; study concepts; J.L.: study design; C.Z.: definition of intellectual content; Y.H.: literature research; J.J.: data acquisition; X.W.: statistical analysis; D.L.: manuscript preparation; T.S.: manuscript editing; M.L.: manuscript review. All authors have read and approved the final version to be submitted.

Xudong Chen, Jianhui Li, Chengfei Zheng, Yunjun He, Junjun Jia, Xiaohui Wang, Donglin Li, Tao Shang and Ming Li

Declaration of financial/other relationships

All authors declared that they have no competing financial interests. A peer reviewer on this manuscript has declared working for Medtronic on projects related to the IN.PACT Admiral drug-coated balloon.