Routine stent implantation vs. percutaneous transluminal angioplasty in femoropopliteal artery disease: a meta-analysis of randomized controlled trials

Aims: We performed a meta-analysis of randomized controlled trialscomparing routine stenting (ST) with percutaneous transluminalangioplasty (PTA) for symptomatic superficial femoral-poplitealartery (SFPA) disease. Methods and results: Ten trials were pooled randomizing patients to ST (n = 724 limbs)or PTA with provisional stenting (n = 718 limbs) with a follow-upperiod of 9–24 months. The mean lesion length was similarin the two groups (45.8 mm in the ST group and 43.3 mm in thePTA group). We calculated the summary risk ratios (RRs) forimmediate technical failure, restenosis, and target vessel revascularization(TVR) using random-effects models. The immediate technical failurewas higher in the PTA group than in the ST group [17.1 vs. 5.9%,respectively, RR = 0.28, 95% confidence interval (CI) = 0.15–0.54,P < 0.001], with 10.3% of the PTA patients undergoing stentingbecause of suboptimal result. There was a trend for lower restenosisin the ST group (37.6% in ST vs. 45.3% in PTA, RR = 0.85, 95%CI = 0.69–1.06, P = 0.146), but no difference in the needfor TVR (20% in ST vs. 20.2% in PTA, RR = 0.98, 95% CI = 0.78–1.23,P = 0.89). In an analysis restricted to nitinol stents, therewas a trend towards reduction in TVR (RR = 0.79, 95% CI = 0.59–1.06,P = 0.12). Conclusion: Despite the higher immediate success, routine stenting was notassociated with a significant reduction in the rate of restenosisor TVR. Our data do not support use of routine stenting as theprimary endovascular treatment for short SFPA lesions.