JVIR twitter

Thursday, February 14, 2019

Angioplasty Versus Stenting for Infrapopliteal Arterial Lesions in Chronic Limb-Threatening Ischaemia (Review)


Clinical question
Is there a benefit to percutaneous transluminal angioplasty (PTA) with stent placement versus PTA alone in the infrapopliteal arterial system in patients with Chronic Limb Threatening Ischemia (CLTI).

Take-away point
Based on review of available suitable studies, there is not enough evidence to suggest that stent placement in addition to PTA is superior to PTA alone the infrapopliteal arterial system provides added patency, and reduction in complications, mortality or amputation in patients with CLTI.

Reference
Hsu CCT et al. Angioplasty Versus Stenting for Infrapopliteal Arterial Lesions In Chronic Limb-Threatening Ischaemia (Review). Cochrane Database of Systematic Reviews 2018, Issue 12. Art No.: CD009195

Click here for abstract

Study design: Meta-analysis (other)

Funding source: Self-funded or unfunded

Setting: Various (meta-analysis)

Summary


Comprehensive review was performed of studies and trials that examined PTA versus PTA with stent placement in the infrapopliteal arteries (anterior tibial, peroneal and posterior tibial arteries, and the tibioperoneal trunk in patients classified with CLTI. After sorting through approximately 14k results, after multifactorial analysis to filter down to randomized or quasi-randomized trials, a total of seven studies were included. These included a variety of stent types (structure/drug presence/permanence) and CLTI stage. The timeframe of the selected studies ranged from 2006-2016. Exclusion criteria included patients that underwent atherectomy.

After analysis of the seven studies, the authors deducted that there was increased technical success rates when stent scaffolding was used. However, they found no significant difference in short term patency, complications, mortality or amputations. A weakness identified in comparing these studies included lack of uniformity of anti-platelet/anti-coagulation regimens.


Commentary


This review attempts to determine if there is sufficient evidence that can help establish superiority of scaffold placement in the infrapopliteal arteries for patients with CLTI. Although patency is considered similar for the two, the 6-month follow-up of most of the included studies is not sufficient enough to draw conclusions. Technical success is considered better with stenting, however availability and experience with tibial stenting would already assume better outcomes. There is considerable variability between the studies, including one study looking at bio absorbable stents (incidentally industry funded), and another that demonstrated a 5-fold increase in size of ulcers that were treated in the stenting cohorts. The lack of uniformity in anti-platelet/anti-coagulation treatment also creates significant bias.

What is clear is that truly randomized studies are needed for this patient population that needs as much patent flow as possible to prevent major amputation and death. This is of particular importance as currently there are self-expanding drug eluting tibial stents that will be shortly available for use, and we all need more understanding as to the appropriateness of stent placement other than as a bailout or clear refractory lesions despite aggressive interventions with differing balloon types and atherectomy.

Post Author:
Kumar Madassery, MD
Assistant Professor, Vascular & Interventional Radiology
Rush University Medical Center
Rush Oak Park Hospital
@kmadass




9 comments:

  1. ADD DR PERFECT ON WHATSAPP +1 (256)-251-3614 AND GET A CURE TO ANY TYPE OF DISEASES AND VIRUS

    I'm so happy and excited to give my testimony of how I was cure of herpes virus. I'm Karen Wilson from Paris France I was diagnosed with herpes virus for 6 years, I took every drugs prescribed to me by the doctors but there was no positive result, so I decided to try if I can find a cure for my herpes online and I saw different people's comments on how Dr Perfect helped them to cure their diseases and viruses I message him urgently on WhatsApp it's didn't take long he replied my message and we talked on how I can get the cure and he told me he will send the cure to me, in four days time the cure was delivered to my house and he gave me instruction on how I will use it, 17 days later there was no sign of herpes in my body then I went for test and the doctor told me he couldn't find any sign of herpes virus in my blood. Dr Perfect herbal cure is the best don't think because he cured me of herpes virus and you are diagnosed with Hepatitis or other virus he can't cure you, Dr Perfect can cure all types of diseases and virus. If you need a cure for your disease and virus WhatsApp him +1 (256)-251-3614 if you are not on WhatsApp email him at solutiontoallproblems1@gmail.com

    ReplyDelete
    Replies
    1. I want to write a little testimony about the good work of doctor ehiaguna who cured me from Hsv 1 and 2 for just 2 week with his herbal medicine, I never believe I can be normal again and have a good life like others I always regretted the day I got diagnose with the virus, I was lost of hope when my doctor told me there is no cure for it but I keep thinking and thinking about my future, if I can have kids of my own well I am so grateful for my helper who get me cured with his herbal medicine, I go online in search of anything that can help me because I can’t deal with it forever so I found this doc ehiaguna email on a blog of someone who was cured by him I quickly contact him for help and explain all my pain to him, he told me not to worry about it there is cure for real, I never believe until he send me the herbal medicine when I order for it and I have it within 4 days that is how I took the medicine for 2 week and the following week I go for test just to confirm I was 100% cured from this sickness what a miracle in my life I am so happy right now, you can also get in contact with him if you have such sickness through drehiaguna@gmail.com and also WhatsApp him +2348073908953... And He also have herbs medicine to cured the following diseases; eczema,urethra wart,chronic problems.Herpes, Cancer, Als,Hepatitis, Diabetes, HPV,Infections,ulcer  ETC

      Delete
  2. My Name is Dr sebi you can Contact Me via Email drsebicurecenter@gmail.com For Penis Enlargement Product to help you get as long as 8inches Long with good Erection. Contact Me Via Email : drsebicurecenter@gmail.com   Via WhatsApp +2347010538590

    ReplyDelete
  3. Herbal Penis Enlargement product is 100% guarantee to Enlarge and get a better ERECTION ,
    the reason why most people are finding it difficult
    to enlarge Penis is because they bedlieve on medical
    report, drugs and medical treatment which is not
    helpful for Penis Enlargement . Natural roots/herbs are the best remedy which can easily Enlarge your Penis permanently
    Contact Dr ABAKA via Email : drabakatemple@gmail.com or via WhatsApp : +2347010538590 for Natural root and herbal remedies put together to help you get Enlarge and Erect healthy.
    Thank you

    ReplyDelete
  4. Love Spells- How I Got My Husband Back.Read more about Dr Sambo his contact details seen below: divinespellhome@gmail.comWhatsApp him now +2348145810121 You can also visit his website http://DrSambo443.website2.meMy husband who departed from me 2 years ago started calling me and wanted us to get back Dr Sambo love spell made my husband to reconcile with me. When he came back he was all on me kissing and rubbing on me telling me how much he missed me and loves me, Dr Sambo is spectacular in repairing relationship! His work is wonderful, i am glad to let you all know that this spell caster have the power to bring lovers back. Because i am now happy with my husband. I highly recommending this service for those experiencing difficulties trying to restore there relationship. he is the real deal. you can reach Dr. Sambo his contact details seen below: divinespellhome@gmail.comWhatsApp  him now+2348145810121 

    ReplyDelete
  5. Love Spells- How I Got My Husband Back.Read more about Dr Sambo his contact details seen below: divinespellhome@gmail.comWhatsApp him now +2348145810121 You can also visit his website http://DrSambo443.website2.meMy husband who departed from me 2 years ago started calling me and wanted us to get back Dr Sambo love spell made my husband to reconcile with me. When he came back he was all on me kissing and rubbing on me telling me how much he missed me and loves me, Dr Sambo is spectacular in repairing relationship! His work is wonderful, i am glad to let you all know that this spell caster have the power to bring lovers back. Because i am now happy with my husband. I highly recommending this service for those experiencing difficulties trying to restore there relationship. he is the real deal. you can reach Dr. Sambo his contact details seen below: divinespellhome@gmail.comWhatsApp  him now+2348145810121 

    ReplyDelete
  6. Love Spells- How I Got My Husband Back.Read more about Dr Sambo his contact details seen below: divinespellhome@gmail.comWhatsApp him now +2348145810121 You can also visit his website http://DrSambo443.website2.meMy husband who departed from me 2 years ago started calling me and wanted us to get back Dr Sambo love spell made my husband to reconcile with me. When he came back he was all on me kissing and rubbing on me telling me how much he missed me and loves me, Dr Sambo is spectacular in repairing relationship! His work is wonderful, i am glad to let you all know that this spell caster have the power to bring lovers back. Because i am now happy with my husband. I highly recommending this service for those experiencing difficulties trying to restore there relationship. he is the real deal. you can reach Dr. Sambo his contact details seen below: divinespellhome@gmail.comWhatsApp  him now+2348145810121 

    ReplyDelete
  7. My Name is Dr sebi you can Contact Me via Email drsebicurecenter@gmail.com For Penis Enlargement Product to help you get as long as 8inches Long with good Erection. Contact Me Via Email : drsebicurecenter@gmail.com Via WhatsApp +2347010538590

    ReplyDelete
  8. I want to write a little testimony about the good work of doctor ehiaguna who cured me from Hsv 1 and 2 for just 2 week with his herbal medicine, I never believe I can be normal again and have a good life like others I always regretted the day I got diagnose with the virus, I was lost of hope when my doctor told me there is no cure for it but I keep thinking and thinking about my future, if I can have kids of my own well I am so grateful for my helper who get me cured with his herbal medicine, I go online in search of anything that can help me because I can’t deal with it forever so I found this doc ehiaguna email on a blog of someone who was cured by him I quickly contact him for help and explain all my pain to him, he told me not to worry about it there is cure for real, I never believe until he send me the herbal medicine when I order for it and I have it within 4 days that is how I took the medicine for 2 week and the following week I go for test just to confirm I was 100% cured from this sickness what a miracle in my life I am so happy right now, you can also get in contact with him if you have such sickness through drehiaguna@gmail.com and also WhatsApp him +2348073908953... And He also have herbs medicine to cured the following diseases; eczema,urethra wart,chronic problems.Herpes, Cancer, Als,Hepatitis, Diabetes, HPV,Infections,ulcer  ETC

    ReplyDelete