title: Systematic Review and Meta-Analysis of Drug-Eluting Balloon and Stent for Infrapopliteal Artery Revascularization.
abstract: BACKGROUND
  Drug-eluting balloon (DEB) and drug-eluting stent (DES) have been proposed for the treatment of infrapopliteal artery disease. We performed a systematic review and meta-analysis of the current available studies investigating outcomes of DEB and DES in the treatment of infrapopliteal artery disease.
  
  
  METHODS
  Multiple databases were systematically searched to identify studies investigating the outcomes of DEB and DES in the treatment of patients with infrapopliteal artery disease. The quality of studies was assessed by Cochrane Collaboration method. The demographic data, risk factors, outcomes, and antiplatelet strategy were extracted.
  
  
  RESULTS
  Nine studies were identified with 707 and 606 patients in DEB/DES and standard percutaneous balloon angioplasty (PTA)/bare metal stenting (BMS) group, respectively. The risk of target lesion revascularization (TLR; odds ratio [OR] = 0.38, 95% confidence interval [CI]: 0.23-0.63, P < .01), restenosis rate (OR = 0.30, 95% CI: 0.18-0.50, P < .01), and amputation rate (OR = 0.49, 95% CI: 0.29-0.83, P < .01) significantly decreased in the DES group. The overall survival (OR = 0.86, 95% CI: 0.56-1.32, P = .50) was similar in DES and standard PTA/BMS group; TLR (OR = 0.59, 95% CI: 0.32-1.09, P = .09), restenosis rate (OR = 0.49, 95% CI: 0.11-2.14, P = .35), amputation rate (OR = 1.32, 95% CI: 0.51-3.40, P = .57), and overall survival (OR = 1.40, 95% CI: 0.72-2.71, P = .32) were similar in DEB and standard PTA group.
  
  
  CONCLUSIONS
  The present meta-analysis suggests that compared with standard PTA/BMS, DES may decrease the risk of clinically driven TLR, restenosis rate, and amputation rate without any impact on mortality. However, DEB has no obvious advantage in the treatment of infrapopliteal disease. Due to the limitations of our study, more randomized controlled trials, especially those for DEB, are necessary.
authors.affiliation: 1 Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China.|2 Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Jianbin
authors.initials: J
authors.lastname: Zhang
authors.affiliation: 2 Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Xiaojie
authors.initials: X
authors.lastname: Xu
authors.affiliation: 1 Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China.|2 Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Kong
authors.affiliation: 1 Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China.|2 Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Rongwei
authors.initials: R
authors.lastname: Xu
authors.affiliation: 1 Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China.
authors.forename: Xueqiang
authors.initials: X
authors.lastname: Fan
authors.affiliation: 1 Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.affiliation: 1 Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China.
authors.forename: Xia
authors.initials: X
authors.lastname: Zheng
authors.affiliation: 1 Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Ma
authors.affiliation: 1 Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China.
authors.forename: Mingsheng
authors.initials: M
authors.lastname: Sun
authors.affiliation: 1 Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China.
authors.forename: Zhidong
authors.initials: Z
authors.lastname: Ye
authors.affiliation: 1 Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China.|2 Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Liu
mesh_terms: D000671:Amputation, Surgical; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016009:Chi-Square Distribution; D020099:Coated Materials, Biocompatible; D003251:Constriction, Pathologic; D054855:Drug-Eluting Stents; D006801:Humans; D023821:Limb Salvage; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D011474:Prosthesis Design; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D062666:Vascular Access Devices; D014654:Vascular Patency
chemical_list: D020099:Coated Materials, Biocompatible
keywords: drug-eluting balloon; drug-eluting stent; infrapopliteal artery