新发股胭动脉病变各种腔内治疗方法疗效与安全性的Meta分析OA北大核心

Background and aims:Endovascular therapy is currently considered the first-line treatment for most patients with symptomatic peripheral artery disease.Recent research has primarily focused on short-or mid-term(≤2 years)follow-up periods,investigating the efficacy differences in endovascular methods for treating newly developed femoropopliteal arterial lesions.However,the optimal endovascular treatment method for newly developed femoropopliteal arterial lesions during long-term follow-up remains unclear.Therefore,this study conducted a network Meta-analysis of randomized controlled trials(RCTs)to compare the efficacy of common balloon angioplasty(BA),bare nitinol stent(BNS),drug-coated balloon(DCB),and drug-eluting stent(DES)implantation during short-term and long-term follow-up in the treatment of newly developed femoropopliteal arterial lesions. Methods:After searching multiple medical databases,a total of 26 RCTs(with a total of 4 480 patients)were included,and a network Meta-analysis was conducted to assess the efficacy and safety of various methods.Outcome measures included primary patency rates at of follow-up,target lesion revascularization(TLR)rates,major amputation rates,and all-cause mortality rates during 1,2,and/or 3 years of follow-up. Results:In terms of primary patency rates at 1,2,and 3 years of follow-up,DES consistently showed to be the most effective treatment method,with its 2-year primary patency rate significantly higher than BA(OR=11.11,95％CI=3.06-40.28),BNS(OR=2.82,95％CI=1.06-7.53),and DCB(OR=4.19,95％CI=1.06-16.51).Regarding TLR rates at 1,2,and 3 years of follow-up,DES again proved to be the most effective treatment method,with its 2-year TLR rate significantly lower than BA(OR=0.08,95％CI=0.03-0.25),BNS(OR=0.43,95％CI=0.19-0.97),and DCB(OR=0.29,95％CI=0.09-0.88).There were no significant differences in major amputation rates among the treatment methods,but the surface under the values of cumulative ranking curve at 1,2,and 3 years indicated that DCB was the most effective method in preventing major amputation.No significant differences were observed in all-cause mortality rates at 1,2,and 3 years among the treatment methods. Conclusions:For the treatment of newly developed femoropopliteal arterial lesions,DES demonstrated higher primary patency rates and lower TLR rates,while DCB may be the most effective method in preventing major amputations.Therefore,DES and DCB should be prioritized in the consideration for treatment.