title: Routine stent implantation vs. percutaneous transluminal angioplasty in femoropopliteal artery disease: a meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  We performed a meta-analysis of randomized controlled trials comparing routine stenting (ST) with percutaneous transluminal angioplasty (PTA) for symptomatic superficial femoral-popliteal artery (SFPA) disease.
  
  
  RESULTS
  Ten trials were pooled randomizing patients to ST (n = 724 limbs) or PTA with provisional stenting (n = 718 limbs) with a follow-up period of 9-24 months. The mean lesion length was similar in the two groups (45.8 mm in the ST group and 43.3 mm in the PTA group). We calculated the summary risk ratios (RRs) for immediate technical failure, restenosis, and target vessel revascularization (TVR) using random-effects models. The immediate technical failure was higher in the PTA group than in the ST group [17.1 vs. 5.9%, respectively, RR = 0.28, 95% confidence interval (CI) = 0.15-0.54, P < 0.001], with 10.3% of the PTA patients undergoing stenting because of suboptimal result. There was a trend for lower restenosis in the ST group (37.6% in ST vs. 45.3% in PTA, RR = 0.85, 95% CI = 0.69-1.06, P = 0.146), but no difference in the need for TVR (20% in ST vs. 20.2% in PTA, RR = 0.98, 95% CI = 0.78-1.23, P = 0.89). In an analysis restricted to nitinol stents, there was a trend towards reduction in TVR (RR = 0.79, 95% CI = 0.59-1.06, P = 0.12).
  
  
  CONCLUSIONS
  Despite the higher immediate success, routine stenting was not associated with a significant reduction in the rate of restenosis or TVR. Our data do not support use of routine stenting as the primary endovascular treatment for short SFPA lesions.
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, MI 48109-5853, USA.
authors.forename: Christos
authors.initials: C
authors.lastname: Kasapis
authors.forename: Peter K
authors.initials: PK
authors.lastname: Henke
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Chetcuti
authors.forename: Gerald C
authors.initials: GC
authors.lastname: Koenig
authors.forename: John E
authors.initials: JE
authors.lastname: Rectenwald
authors.forename: Venkataramu N
authors.initials: VN
authors.lastname: Krishnamurthy
authors.forename: Paul Michael
authors.initials: PM
authors.lastname: Grossman
authors.forename: Hitinder S
authors.initials: HS
authors.lastname: Gurm
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000601:surgery / Q000628:therapy*; D011150:Popliteal Artery; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012306:Risk; D015607:Stents; D016896:Treatment Outcome