Balloon dilation and stent implantation for treatment of femoropopliteal arterial disease: Meta-analysis

PURPOSE: To perform a meta-analysis of long-term results of balloon dilatio n and stent implantation in the treatment of femoropopliteal arterial disea se. MATERIALS AND METHODS: The English-language literature was searched for stu dies published between 1993 and 2000. Inclusion criteria for articles were presentation of long-term primary patency rates, standard errors (explicitl y reported or derivable), and baseline characteristics of the study populat ion. Two reviewers independently able) extracted data, and discrepancies we re resolved by consensus. Primary patency rates were combined by using a te chnique that allows adjustment for differences across study populations. An alyses were adjusted for lesion type and clinical indication. RESULTS: Nineteen studies met the inclusion criteria, representing 923 ball oon dilations and 473 stent implantations. Combined 3-year patency rates af ter balloon dilation were 61% (standard error, 2.2% for stenoses and claudi cation, 48% (standard error, 3.3%) for occlusions and claudication, 43% (st andard error, 4.1%) for stenoses and critical ischemia, and 30% (standard e rror, 3.7%) for occlusions and critical ischemia. The 3-year patency rates after stent implantation were 63%-66% (standard error, 4.1%) and were indep endent of clinical indication and lesion type. Funnel plots demonstrated an asymmetric distribution of the data points associated with stent studied. CONCLUSION: Balloon dilation and stent implantation for claudication and st enosis yield similar long-term patency rates. For more severe femoropoplite al disease, the results of stent implantation seem more favorable. Publicat ion bias could not be ruled out.