Cool Excimer Laser-Assisted Angioplasty vs. Percutaneous Transluminal Angioplasty for Infrapopliteal Arterial Occlusion: A Meta-Analysis and Systematic Review.

cool excimer laser-assisted angioplasty endovascular intervention infrapopliteal arterial occlusion percutaneous transluminal angioplasty peripheral arterial disease

Journal

Frontiers in cardiovascular medicine

ISSN: 2297-055X

Titre abrégé: Front Cardiovasc Med

Pays: Switzerland

ID NLM: 101653388

Informations de publication

Date de publication:
2021

Historique:

received: 26 09 2021

accepted: 27 12 2021

entrez: 21 2 2022

pubmed: 22 2 2022

medline: 22 2 2022

Statut: epublish

Résumé

Percutaneous transluminal angioplasty (PTA) has been the conventional therapy to infrapopliteal arterial occlusion. Lately, cool excimer laser-assisted angioplasty has been proposed to be the alternate methods. We performed a systematic review and meta-analysis of prospective and retrospective cohort studies and randomized controlled trials to assess the effect of cool excimer laser-assisted angioplasty vs. tibial balloon angioplasty in patients with infrapopliteal arterial occlusion. We systematically searched PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) (all up to April, 2021). All prospective and retrospective cohort studies and randomized controlled trials comparing clinical outcomes between cool excimer laser-assisted angioplasty and tibial balloon angioplasty were included. The main endpoints were amputation-free survival (AFS), primary patency (6 months and 12 months) and free from target lesion revascularization (TLR) (3 years). Secondary outcomes included the major amputation (1 year), dissection, embolization and bailout stent. We chose the effect model according to studies' heterogeneity. A total of 122 articles were found. According to inclusion criteria, 6 papers were finally selected for the detailed evaluation. Of the 6 papers, 4 were prospective cohort studies, and 2 were retrospective studies. Compared with PTA, CELA significantly increased the rate of patency (6 months: MD 13.01, 95% CI 3.12-22.90, CELA had superior clinical (freedom from TLR) and angiographic outcomes (patency rate) for infrapopliteal arterial occlusion at the same time CELA does not have increased intervention-related complications compared to PTA. However, CELA is unable to improve the patient's limb salvage rate compared with PTA.

Sections du résumé

BACKGROUND BACKGROUND

METHODS AND RESULTS RESULTS

We systematically searched PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) (all up to April, 2021). All prospective and retrospective cohort studies and randomized controlled trials comparing clinical outcomes between cool excimer laser-assisted angioplasty and tibial balloon angioplasty were included. The main endpoints were amputation-free survival (AFS), primary patency (6 months and 12 months) and free from target lesion revascularization (TLR) (3 years). Secondary outcomes included the major amputation (1 year), dissection, embolization and bailout stent. We chose the effect model according to studies' heterogeneity. A total of 122 articles were found. According to inclusion criteria, 6 papers were finally selected for the detailed evaluation. Of the 6 papers, 4 were prospective cohort studies, and 2 were retrospective studies. Compared with PTA, CELA significantly increased the rate of patency (6 months: MD 13.01, 95% CI 3.12-22.90,

CONCLUSIONS CONCLUSIONS

CELA had superior clinical (freedom from TLR) and angiographic outcomes (patency rate) for infrapopliteal arterial occlusion at the same time CELA does not have increased intervention-related complications compared to PTA. However, CELA is unable to improve the patient's limb salvage rate compared with PTA.

Identifiants

DOI: 10.3389/fcvm.2021.783358 PMID: 35187104 PMC: PMC8847249

pubmed: 35187104

doi: 10.3389/fcvm.2021.783358

pmc: PMC8847249

doi:

Types de publication

Systematic Review

Langues

eng

Pagination

783358

Informations de copyright

Déclaration de conflit d'intérêts

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Références

J Endovasc Ther. 2002 Dec;9(6):882-8

pubmed: 12546591

J Am Coll Cardiol. 2012 Aug 14;60(7):587-91

pubmed: 22878166

Front Cardiovasc Med. 2015 Jan 07;1:17

pubmed: 26664867

J Endovasc Ther. 2014 Feb;21(1):52-60

pubmed: 24502484

J Vasc Surg. 2008 May;47(5):975-981

pubmed: 18372148

J Am Coll Cardiol. 1985 Apr;5(4):929-33

pubmed: 3838324

Cardiovasc Interv Ther. 2014 Apr;29(2):109-16

pubmed: 24155171

Lasers Med Sci. 2001;16(2):101-7

pubmed: 11484750

JACC Cardiovasc Interv. 2015 Jan;8(1 Pt A):92-101

pubmed: 25499305

J Endovasc Ther. 2013 Oct;20(5):707-13

pubmed: 24093325

Vascular. 2006 Mar-Apr;14(2):63-9

pubmed: 16956473

Cardiovasc Revasc Med. 2021 Feb;23:79-83

pubmed: 32952073

Circulation. 2006 Mar 21;113(11):e463-654

pubmed: 16549646

JACC Cardiovasc Interv. 2014 Aug;7(8):923-33

pubmed: 25147039

Cardiol Clin. 2015 Feb;33(1):37-47

pubmed: 25439329

Interv Neuroradiol. 2000 Nov 30;6 Suppl 1:237-42

pubmed: 20667256

Eur J Vasc Endovasc Surg. 2006 Nov;32(5):484-90

pubmed: 16730466

J Endovasc Ther. 2006 Feb;13(1):1-11

pubmed: 16445313

Circulation. 1984 Oct;70(4):619-23

pubmed: 6236912

Eur J Vasc Endovasc Surg. 2009 Mar;37(3):336-42

pubmed: 19112033

J Endovasc Ther. 2009 Dec;16(6):653-62

pubmed: 19995118

J Vasc Surg. 2011 Feb;53(2):347-52

pubmed: 21129906

Circulation. 1997 Oct 7;96(7):2183-9

pubmed: 9337188

J Endovasc Ther. 2006 Oct;13(5):603-8

pubmed: 17042661

Vasc Endovascular Surg. 2013 Apr;47(3):179-91

pubmed: 23448976

J Vasc Surg. 2007 Aug;46(2):289-295

pubmed: 17600661

Lancet. 2000 Jun 3;355(9219):1976

pubmed: 10859049

Eur J Vasc Surg. 1992 May;6 Suppl A:1-32

pubmed: 1533191

Eur J Vasc Surg. 1990 Dec;4(6):575-81

pubmed: 2279566

Catheter Cardiovasc Interv. 2015 Dec 1;86(7):1211-8

pubmed: 26489379

Angiology. 1998 Feb;49(2):91-8

pubmed: 9482508

J Laser Appl. 1998 Feb;10(1):34-40

pubmed: 10177221

Circulation. 2013 Aug 6;128(6):615-21

pubmed: 23797811

Eur J Vasc Endovasc Surg. 2012 Oct;44(4):425-31

pubmed: 22938944

Catheter Cardiovasc Interv. 2010 Dec 1;76(7):1047-54

pubmed: 20518006