The use of stents that not only open a clogged artery but also provide targeted release of a drug is demonstrating favorable results. There is controversy over whether the drug-eluting stent or the bare metal stent has superior clinical benefit. Numerous studies, however, are indicating successful trials of procedures using the drug-eluting stent to keep vessels in the leg open.
The authors of an article published in the Journal of Endovascular Therapy compare the use of bare metal stents with drug-eluting stents in the treatment of infrapopliteal occlusive disease. The article is a meta-analysis of the results of six studies four randomised trials and two observational studies that included 544 patients.
Peripheral artery disease affects a significant portion of the population. With the rising prevalence of diabetes, severe limb ischemia is also expected to increase. Reconstruction of the arteries through surgery is the primary treatment, but drug-eluting stents could offer a less invasive option.
The drug-eluting stent releases drugs to the vessel wall to prevent inflammation and proliferation of cells, thus improving treatment outcomes. At the one-year point, the results of these studies are promising. Patency of the vessel to allow free flow of blood and clinical improvements have increased, and revascularization of the target lesion due to reclosure is low.
What these studies are not able to tell us at this point is whether longer-term effects will be as encouraging. Parameters such as saving of limbs and healing of wounds have yet to be assessed.
The authors discuss the pros and cons of meta-analyses. They compare megatrials—which offer to definitively settle an issue by studying large numbers of subjects—to a Big Mac, while they describe systematic reviews and meta-analyses, which pool results of smaller studies, as a bowl of Cheerios.
Despite the recent burst of popularity for meta-analyses within the literature, the authors praise the careful analysis of drug-eluting stents presented in this issue of the journal. They caution that not all types of drug-eluting stents are equal and that these study findings should not be generalised to all types. Nevertheless, they find this analysis to be “recommended reading” for endovascular specialists.
Journal of Endovascular Therapy
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