Infragenicular stent implantation for below-the-knee atherosclerotic disease: clinical evidence from an international collaborative meta-analysis on 640 patients.
OBJECTIVE
To report a systematic review of the literature published on the outcomes of stenting for below-the-knee disease in patients with critical limb ischemia (CLI).


METHODS
Potentially relevant studies of stent implantation in the infragenicular arteries in >or=5 patients with >or=1-month follow-up were systematically sought in BioMedCentral, ClinicalTrials.gov, The Cochrane Collaboration Register of Controlled Trials (CENTRAL), Google Scholar, and PubMed. Data were abstracted and pooled with a random-effect model to generate risk estimates with 95% confidence intervals (CI). Interaction tests were performed to compare different stent types. A risk of bias assessment was conducted separately, as were appraisals for small study bias, statistical heterogeneity, and inconsistency.


RESULTS
Eighteen nonrandomized studies were retrieved comprising 640 patients. After a median follow-up of 12 months, binary in-stent restenosis occurred in 25.7% (95% CI 11.6% to 40.0%), primary patency in 78.9% (95% CI 71.8% to 86.0%), improvement in Rutherford class in 91.3% (95% CI 85.5% to 97.1%), target vessel revascularization in 10.1% (95% CI 6.2% to 13.9%), and limb salvage in 96.4% (95% CI 94.7% to 98.1%). Head-to-head comparisons showed that sirolimus-eluting stents were superior to balloon-expandable bare metal stents in preventing restenosis and increasing primary patency (both p<0.001); sirolimus-eluting stents were also better than paclitaxel-eluting stents in terms of primary patency (p<0.001) and repeat revascularizations (p = 0.014).


CONCLUSIONS
Percutaneous infragenicular stent implantation after failed or unsuccessful balloon angioplasty is associated with favorable clinical results in patients with CLI. Notwithstanding limitations of primary studies, sirolimus-eluting stents appear superior to bare metal and paclitaxel-eluting stents in terms of angiographic and/or clinical outcomes.
Biondi-Zoccai
Giuseppe G L
GG
Division of Cardiology, University of Turin, Italy. gbiondizoccai@gmail.com
Sangiorgi
Giuseppe
G
Lotrionte
Marzia
M
Feiring
Andrew
A
Commeau
Philippe
P
Fusaro
Massimiliano
M
Agostoni
Pierfrancesco
P
Bosiers
Marc
M
Peregrin
Jan
J
Rosales
Oscar
O
Cotroneo
Antonio R
AR
Rand
Thomas
T
Sheiban
Imad
I
D017130:Angioplasty; D050197:Atherosclerosis / Q000628:therapy*; D004867:Equipment Design; D006801:Humans; D007866:Leg / Q000098:blood supply*; D016491:Peripheral Vascular Diseases / Q000628:therapy*; D015607:Stents