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

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.