Drug Eluting Stents as a Management for Patients with Below the Knee Peripheral Artery Disease: A Systematic Review and Meta-Analysis.

PurposeThe purpose of this study was to compare the effectiveness and safety of drug eluting stents with percutaneous transluminal angioplasty and bare-metal stents in below the knee peripheral artery disease. Methods: The systematic review was registered in Research Registry. A literature search was performed across four databases: PubMed, Medline/Embase, Cochrane Review, and Web of Science for eligible comparative studies. The primary outcomes examined were mortality, major amputation (above the ankle), minor amputation (below the ankle), and clinically driven target lesion revascularization (CD-TLR). A random effects model was used when pooling outcomes to account for heterogeneity.Main FindingsA total of 7 studies were included in this systematic review and meta-analysis. All subjects were treated for below the knee lesions and CLTI was confirmed as Rutherford ≥4 in 669/955 (70.0%). Among the studies, 572 were treated with a drug eluting stents and 477 treated with non-DES modalities. Pooled analysis showed that DES significantly reduced minor amputations and CD-TLR, O.R = 0.56 [0.32, 0.96], and O.R = 0.38 [0.25, 0.60], respectively. In subgroup analysis, paclitaxel eluting stents were not associated with either survival or major amputation. Everolimus/sirolimus eluting stent use was associated with reduced CD-TLR, O.R = 0.36 [0.21, 0.61].ConclusionThis study suggests that Drug-Eluting Stents (DES), irrespective of type, provide protection against minor amputations and CD-TLR. However, they do not seem to have a significant impact on overall survival rates or the risk of major amputations.