Abstract 17377: Comparison of Drug Eluting Stents versus Bare Metal Stents in Femoropopliteal Artery Occlusive Disease. A Systematic Review and Meta-Analysis
Background: Femoropopliteal artery occlusive disease could manifest as mild disease or to critical limb ischemia leading to claudication, amputation, and even death.Percutaneous transluminal angioplasty for occlusive femoropopliteal arteries is a recommended strategy but with a high restenosis rate of 50%. Bare metal stent (BMS) implantation may reduce the restenosis but still at a high rate of 20-37%. The high success rate noted in the utilization of drug eluting stents (DES) in coronary intervention was the impetus for its utilization in peripheral intervention. Initial studies on use of DES in peripheral artery intervention were encouraging and as of this writing meta-analysis comparing these two stents have not been done yet.
Methods: A comprehensive search of electronic databases of both published and unpublished literature were done. Only randomized studies were included.Two reviewers independently assessed the studies meeting the inclusion criteria according to pre-defined parameters on methodological quality of research papers. Data from each study were also independently extracted using pre-set data forms. Fixed effects analysis of combined data was done and results were expressed in relative risk and mean difference for dichotomous and continuous outcomes respectively.
Results: Five clinical trials met the inclusion criteria. Results showed that utilization of drug eluting stents as compared to bare metal stents yielded a better arterial patency rate (RR 1.41 CI 1.23-1.61), reduced restenosis rate (RR 0.46 CI 0.33-0.63), and lesser tendency for repeat revascularization (RR 0.29 CI 0.16-0.51). However, no statistical significance was noted between the two interventions concerning mortality rate (RR 0.93 CI 0.47-1.83) and ankle brachial index score (mean difference of 0.06 CI 0.02-0.09).
Conclusions: DES implantation yielded better angiographic (arterial patency and restenosis rate) and clinical outcomes (need for repeat revascularization) as compared to BMS implantation in patients who underwent peripheral artery intervention. However, there was no significant difference with mortality rate and ankle brachial index score between these two type of stents.
- © 2012 by American Heart Association, Inc.