Comparison of Different Endovascular Treatments of Femoropopliteal Artery In-Stent Restenosis: A Systematic Review and Bayesian Network Meta-Analysis

Abstract

ObjectiveThis Bayesian network meta-analysis sought to evaluate the efficacy of different endovascular treatments for femoropopliteal in-stent restenosis (FP-ISR). MethodsPubMed, Embase, Cochrane Central Register of Controlled Trials and Web of science for clinical trials from database inception to 31 March 2023, with no language restrictions to retrieve randomized controlled trials (RCTs) or cohort studies evaluating the impact of any kind of endovascular treatments for FP-ISR. Pair-wise meta-analysis and Bayesian network meta-analysis were performed to pool the outcome estimates different endovascular treatments. The primary endpoints under consideration were primary patency rates at both 6- and 12-month follow up. ResultsA total of 15 studies with 1424 patients were ultimately enrolled to be analyzed, 7 types of endovascular treatment were identified for comparison. In terms of primary patency and freedom from target lesion revascularization (F-TLR) at 6-,12-month follow-up, the direct meta-analysis findings showed that drug coated balloons (DCB) and CS are considerably superior to plain old balloon angioplasty (POBA), Excimer laser atherectomy (ELA)+DCB is significantly better than DCB. According to the meta-analysis based on Bayesian theory, during the 6-,12-months follow-up, we couldn’t find significant difference between the different treatments in terms of the primary patency and the freedom from TLR, based on the surface values under the cumulative ranking curve (SUCRA), CS was considered the best treatment in terms of primary patency(6 months SUCRA=85.2; 12 months SUCRA=78.9) and freedom from TLR(6 months SUCRA=84.9; 12 months SUCRA=70.9); directional atherectomy (DA)+POBA may lead to higher survival rate at 12 months(SUCRA=89.1) than others treatments; in addition, both ELA+POBA and ELA+DCB have higher limb salvage than POBA. ConclusionThe findings of this network meta-analysis suggest that CS showed positive encouraging results in primary patency and TLR in femoropopliteal ISR at 6, 12 months. However, due to the potential influence of certain confounding factors, the long-term results necessitate validation through numerous RCTs.