Comparison of clinical outcomes of drug-coated balloons angioplasty vs. plain old balloons angioplasty for peripheral arterial disease: an umbrella meta-analysis
BackgroundPeripheral artery disease (PAD) affects millions globally, causing significant morbidity. Traditional treatments like plain old balloon angioplasty (POBA) have limited success due to high restenosis rates. Drug-coated balloon angioplasty (DCBA) has emerged as a promising alternative, local...
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Frontiers Media S.A.
2024-11-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1511268/full |
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| author | Jiacheng Li Wei Lu Lihong Lin Jiawen Wu Guobing Cheng Qiang Hu Yi Guo |
| author_facet | Jiacheng Li Wei Lu Lihong Lin Jiawen Wu Guobing Cheng Qiang Hu Yi Guo |
| author_sort | Jiacheng Li |
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| description | BackgroundPeripheral artery disease (PAD) affects millions globally, causing significant morbidity. Traditional treatments like plain old balloon angioplasty (POBA) have limited success due to high restenosis rates. Drug-coated balloon angioplasty (DCBA) has emerged as a promising alternative, locally delivering antiproliferative drugs like paclitaxel to reduce restenosis. However, the clinical outcomes of DCBA compared to POBA remain inconsistent across various studies.ObjectiveThis umbrella meta-analysis aimed to compare the clinical outcomes of DCBA and POBA in PAD patients, synthesizing data from multiple meta-analyses to provide a more robust evidence base.MethodsWe conducted an umbrella meta-analysis following PRISMA guidelines, systematically reviewing Cochrane Library, Embase, PubMed, and Web of Science. Studies were included if they compared DCBA and POBA in PAD patients, focusing on primary outcomes such as target lesion revascularization (TLR), primary patency (PP), all-cause mortality (ACM), and amputation. Secondary outcomes included restenosis, late lumen loss (LLL), and major adverse events (MAE).ResultsSixteen meta-analyses were included. DCBA significantly reduced the risk of TLR (OR: 0.41, 95% CI: 0.34–0.49), PP was significantly higher in DCBA (OR: 2.05, 95% CI: 1.53–2.75), and restenosis was lower (OR: 0.46, 95% CI: 0.41–0.51). No significant differences were found in ACM or amputation risk between the two groups. Heterogeneity was moderate to high across most outcomes.ConclusionDCBA provides significant advantages over POBA in reducing TLR and restenosis while maintaining vessel patency. However, the effects on ACM and amputation remain inconclusive. Future research should focus on long-term safety and identifying which patient subgroups benefit most from DCBA.Systematic Review Registrationhttps://www.crd.york.ac.uk/, PROSPERO [CRD42024591967]. |
| format | Article |
| id | doaj-art-3f7cfa44809d4063a9dd9dbd3875fd5a |
| institution | Kabale University |
| issn | 2297-055X |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj-art-3f7cfa44809d4063a9dd9dbd3875fd5a2024-11-21T06:23:47ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2024-11-011110.3389/fcvm.2024.15112681511268Comparison of clinical outcomes of drug-coated balloons angioplasty vs. plain old balloons angioplasty for peripheral arterial disease: an umbrella meta-analysisJiacheng Li0Wei Lu1Lihong Lin2Jiawen Wu3Guobing Cheng4Qiang Hu5Yi Guo6Department of Vascular Surgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, Zhejiang, ChinaDepartment of Vascular Surgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, Zhejiang, ChinaDepartment of Nosocomial Infection Control, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, Zhejiang, ChinaDepartment of Vascular Surgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, Zhejiang, ChinaDepartment of Vascular Surgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, Zhejiang, ChinaDepartment of Vascular Surgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, Zhejiang, ChinaDepartment of Nosocomial Infection Control, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, Zhejiang, ChinaBackgroundPeripheral artery disease (PAD) affects millions globally, causing significant morbidity. Traditional treatments like plain old balloon angioplasty (POBA) have limited success due to high restenosis rates. Drug-coated balloon angioplasty (DCBA) has emerged as a promising alternative, locally delivering antiproliferative drugs like paclitaxel to reduce restenosis. However, the clinical outcomes of DCBA compared to POBA remain inconsistent across various studies.ObjectiveThis umbrella meta-analysis aimed to compare the clinical outcomes of DCBA and POBA in PAD patients, synthesizing data from multiple meta-analyses to provide a more robust evidence base.MethodsWe conducted an umbrella meta-analysis following PRISMA guidelines, systematically reviewing Cochrane Library, Embase, PubMed, and Web of Science. Studies were included if they compared DCBA and POBA in PAD patients, focusing on primary outcomes such as target lesion revascularization (TLR), primary patency (PP), all-cause mortality (ACM), and amputation. Secondary outcomes included restenosis, late lumen loss (LLL), and major adverse events (MAE).ResultsSixteen meta-analyses were included. DCBA significantly reduced the risk of TLR (OR: 0.41, 95% CI: 0.34–0.49), PP was significantly higher in DCBA (OR: 2.05, 95% CI: 1.53–2.75), and restenosis was lower (OR: 0.46, 95% CI: 0.41–0.51). No significant differences were found in ACM or amputation risk between the two groups. Heterogeneity was moderate to high across most outcomes.ConclusionDCBA provides significant advantages over POBA in reducing TLR and restenosis while maintaining vessel patency. However, the effects on ACM and amputation remain inconclusive. Future research should focus on long-term safety and identifying which patient subgroups benefit most from DCBA.Systematic Review Registrationhttps://www.crd.york.ac.uk/, PROSPERO [CRD42024591967].https://www.frontiersin.org/articles/10.3389/fcvm.2024.1511268/fullballoon angioplastypaclitaxelperipheral arterial diseasesystematic reviewumbrella review |
| spellingShingle | Jiacheng Li Wei Lu Lihong Lin Jiawen Wu Guobing Cheng Qiang Hu Yi Guo Comparison of clinical outcomes of drug-coated balloons angioplasty vs. plain old balloons angioplasty for peripheral arterial disease: an umbrella meta-analysis Frontiers in Cardiovascular Medicine balloon angioplasty paclitaxel peripheral arterial disease systematic review umbrella review |
| title | Comparison of clinical outcomes of drug-coated balloons angioplasty vs. plain old balloons angioplasty for peripheral arterial disease: an umbrella meta-analysis |
| title_full | Comparison of clinical outcomes of drug-coated balloons angioplasty vs. plain old balloons angioplasty for peripheral arterial disease: an umbrella meta-analysis |
| title_fullStr | Comparison of clinical outcomes of drug-coated balloons angioplasty vs. plain old balloons angioplasty for peripheral arterial disease: an umbrella meta-analysis |
| title_full_unstemmed | Comparison of clinical outcomes of drug-coated balloons angioplasty vs. plain old balloons angioplasty for peripheral arterial disease: an umbrella meta-analysis |
| title_short | Comparison of clinical outcomes of drug-coated balloons angioplasty vs. plain old balloons angioplasty for peripheral arterial disease: an umbrella meta-analysis |
| title_sort | comparison of clinical outcomes of drug coated balloons angioplasty vs plain old balloons angioplasty for peripheral arterial disease an umbrella meta analysis |
| topic | balloon angioplasty paclitaxel peripheral arterial disease systematic review umbrella review |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1511268/full |
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