A network Meta-analysis of comparing balloon angioplasty, bare metal stent, drug-eluting balloon and drug-eluting stent for infrapopliteal artery occlusive lesions

Objective To explore the efficacy of balloon angioplasty (BA) , bare metal stent (BMS) , drug-eluting balloon (DEB) and drug-eluting stent (DES) for infrapopliteal artery occlusive disease. Methods Medline, Embase database and the Cochrane library were searched for all randomized controlled trials (RCTs) comparing the efficacy of the four treatments mentioned above. The Cochrane Collaboration’s tool was used to assess the risk of bias of selected RCTs. STATA 15 was used to conduct network meta-analysis of selected RCTs with random effect model. Predictive interval plot was used to describe the differences between the four treatments in terms of primary patency, target lesion revascularization (TLR) , major amputation and mortality at the 12-month follow-up. Surface under the cumulative ranking curve (SUCRA) and rank probability were used to rank the four treatments. Results A total of 12 studies, including 1 723 patients, were considered eligible. DES significantly increased primary patency compared to BA (OR=3.00, 95% CI:1.19-7.58) and BMS (OR=3.15, 95%CI: 1.23-8.08) . DEB significantly decreased TLR compared to BA (OR=0.40, 95%CI: 0.16-0.99) . According to the value of SUCRA and ranking probability, DES was considered the best treatment in terms of primary patency (SUCRA value 85.3, probability of the best treatment 59.1%) , TLR (SUCRA value 85.8, probability of the best treatment 65.1%) and major amputation (SUCRA value 94.6, probability of the best treatment 86.7%) ; DEB was considered better than BA and BMS in terms of primary patency and TLR, but it was considered the worst treatment in terms of major amputation and mortality (SUCRA value 21.4 and 12.6 respectively) . Conclusions DES has obvious advantages in terms of primary patency, TLR and major amputation.DEB may be better than BA and BMS in improving primary patency and decreasing TLR, but it has no advantages in terms of major amputation and mortality. Key words: Balloon angioplasty; Bare metal stents; Drug-eluting stents; Drug-eluting balloons; Infrapopliteal arteries; Network meta-analysis