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Network Meta-analysis of Randomised Controlled Trials Comparing the Outcomes of Different Endovascular

Shivshankar Thanigaimani1, David Sun2, Usama Ahmad3

  • 1Queensland Research Centre for Peripheral Vascular Disease (QRC-PVD), College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia.

European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery
|May 16, 2024
PubMed

Insights

Current evidence does not show that drug-coated balloons, stents, or atherectomy are superior to plain balloon angioplasty for treating chronic limb-threatening ischemia. Larger trials are needed to determine the best endovascular revascularization strategy to prevent amputation and death.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Endovascular Therapy

Background:

  • Chronic limb-threatening ischemia (CLTI) is a severe condition requiring effective revascularization.
  • Endovascular procedures are a common treatment modality for CLTI.
  • Comparing the efficacy of various endovascular techniques is crucial for optimal patient outcomes.

Purpose of the Study:

  • To compare the effectiveness of different endovascular revascularization procedures for CLTI.
  • To determine if drug-coated balloons (DCB), bare metal stents (BMS), drug-coated stents (DCS), or atherectomy are superior to plain balloon angioplasty (PBA).

Main Methods:

  • A network meta-analysis (NMA) of randomized controlled trials (RCTs) was conducted.
  • Searched PubMed and Cochrane Central Register for RCTs up to March 14, 2023.
  • Primary outcomes were major amputation and death; risk of bias was assessed using the Cochrane tool.

Main Results:

  • Eleven trials included 2,655 participants with CLTI.
  • No endovascular strategy significantly reduced major amputation or death compared to PBA.
  • GRADE certainty of evidence varied from moderate (DCB) to very low (DCS) for amputation outcomes versus PBA.

Conclusions:

  • Current RCT evidence does not support the superiority of BMS, DCB, DCS, or atherectomy over PBA for preventing major amputation and death in CLTI patients.
  • Larger comparative RCTs are necessary to identify the optimal endovascular revascularization strategy for CLTI.
Abstract

Keywords:
Chronic limb threatening ischaemiaEndovascular revascularisationInfra-inguinalNetwork meta-analysisPeripheral arterial disease

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