Comparison of Different Endovascular Treatments of Femoropopliteal Artery In-Stent Restenosis: A Systematic Review and Bayesian Network Meta-Analysis

Hui Wang; SenSen Wu; Mario D'Oria; Dikang Pan; Lefan Hu; Hanyu Zhang; Jianming Guo; Yongquan Gu

doi:10.1016/j.avsg.2023.12.081

Comparison of Different Endovascular Treatments of Femoropopliteal Artery In-Stent Restenosis: A Systematic Review and Bayesian Network Meta-Analysis

Ann Vasc Surg. 2024 Mar 16:104:205-216. doi: 10.1016/j.avsg.2023.12.081. Online ahead of print.

Authors

Hui Wang¹, SenSen Wu¹, Mario D'Oria², Dikang Pan¹, Lefan Hu¹, Hanyu Zhang¹, Jianming Guo¹, Yongquan Gu³

Affiliations

¹ Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
² Division of Vascular and Endovascular Surgery, University of Trieste, Trieste, Italy.
³ Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China. Electronic address: gu15901598209@aliyun.com.

PMID: 38492725
DOI: 10.1016/j.avsg.2023.12.081

Abstract

Background: This Bayesian network meta-analysis (NMA) sought to evaluate the efficacy of different endovascular treatments for femoropopliteal artery in-stent restenosis (FP-ISR).

Methods: PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of science for clinical trials from database inception to March 31, 2023, with no language restrictions to retrieve randomized controlled trials or cohort studies evaluating the impact of any kind of endovascular treatments for FP-ISR. Pair-wise meta-analysis and Bayesian NMA were performed to pool the outcome estimates different endovascular treatments. The primary end points under consideration were primary patency rates at both 6-month and 12-month follow-up.

Results: A total of 15 studies with 1,424 patients were ultimately enrolled to be analyzed, 7 types of endovascular treatment were identified for comparison. In terms of primary patency and freedom from target lesion revascularization (TLR) at 6-month and12-month follow-up, the direct meta-analysis findings showed that drug-coated balloons (DCB) and covered stent (CS) are considerably superior to plain old balloon angioplasty (POBA), Excimer laser atherectomy (ELA) + DCB is significantly better than DCB. According to the meta-analysis based on Bayesian theory, during the 6-month and 12-months follow-up, we could not find significant difference between the different treatments in terms of the primary patency and the freedom from TLR, based on the surface values under the cumulative ranking curve (SUCRA), CS was considered the best treatment in terms of primary patency (6 months SUCRA = 85.2; 12 months SUCRA = 78.9) and freedom from TLR (6 months SUCRA = 84.9; 12 months SUCRA = 70.9); directional atherectomy + POBA may lead to higher survival rate at 12 months (SUCRA = 89.1) than others treatments; in addition, both ELA + POBA and ELA + DCB have higher limb salvage than POBA.

Conclusions: The findings of this NMA suggest that CS showed positive encouraging results in primary patency and TLR in FP-ISR at 6 and 12 months. However, due to the potential influence of certain confounding factors, the long-term results necessitate validation through numerous randomized controlled trials.

Publication types

Review