Endovascular stents for intermittent claudication
Paul Bachoo1, P A Thorpe, Heather Maxwell
1Ward 36, Vascular Surgery, Aberdeen Royal infirmary, Foresterhill, Aberdeen, Scotland, UK.
Insights
Endovascular stents combined with angioplasty did not significantly improve walking distance or arterial patency in patients with intermittent claudication compared to angioplasty alone. More large-scale trials are needed to confirm these findings for peripheral artery disease treatment.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Peripheral Artery Disease
Background:
- Endovascular stents are explored to enhance arterial patency post-angioplasty for intermittent claudication.
- This review updates a 2002 Cochrane review on the topic.
Purpose of the Study:
- To evaluate if endovascular stents, alongside percutaneous transluminal angioplasty (PTA), improve claudication symptoms compared to PTA alone.
- To test the null hypothesis that stenting offers no added benefit.
Main Methods:
- Systematic review of randomized trials comparing PTA with stenting versus PTA alone.
- Searched Cochrane databases up to August 2009.
- Assessed trial quality and extracted data on restenosis, reocclusion, and walking distance.
Main Results:
- Included two studies with 104 participants, all with femoro-popliteal disease.
- Compared Palmaz stent plus PTA versus PTA alone.
- No significant differences in arterial patency or secondary outcomes were found between groups when studies were combined.
Conclusions:
- Limited by small sample sizes and methodological weaknesses in the included studies.
- Current evidence does not strongly support the routine use of stents in this context.
- Larger, multicenter trials are required to guide clinical practice.
Background:
Endovascular stents have been suggested as a means to improve the patency of arteries after angioplasty in patients with intermittent claudication. This is an update of a Cochrane review published in 2002.
Objectives:
The null hypothesis to be tested by this review is that for individuals with claudication the use of an endovascular stent, in addition to percutaneous transluminal angioplasty, does not improve symptoms of life-style limiting claudication when compared to percutaneous angioplasty alone.
Search Strategy:
For this update the Cochrane Peripheral Vascular Diseases Group searched their Specialised Register (last searched August 2009) and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (last searched 2009, Issue 3).
Selection Criteria:
Randomised trials comparing angioplasty alone versus angioplasty with endovascular stents in patients with intermittent claudication.
Data Collection And Analysis:
Two authors independently assessed trial quality and extracted the data. Only published trial data were used but unpublished data were sought for the update. Effectiveness was measured by the pre-defined primary outcome measures restenosis or reocclusion rates and maximum walking distance.
Main Results:
Two studies were included involving a total of 104 participants. Both studies included only individuals with femoro-popliteal disease. They compared angioplasty and stenting with the Palmaz stent against angioplasty alone. Although one study showed a slight statistical advantage in arterial patency after angioplasty alone, this was not found when the two studies were combined. No differences in the secondary outcomes were detected in either study.
Authors' Conclusions:
The small number of relevant studies identified together with the small sample sizes and methodological weaknesses severely limit the usefulness of this review in guiding practice. The results from larger multicentre trials are needed.
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