Meta-analysis of the results of percutaneous transluminal angioplasty and stent placement for aortoiliac occlusive disease.

Abstract

PURPOSE: To estimate and compare the results of percutaneous transluminal angioplasty (PTA) and stent placement to treat aortoiliac occlusive disease. MATERIALS AND METHODS: A meta-analysis was performed of data in six PTA studies (1,300 patients) and eight stent placement studies (816 patients) published in 1990 or later that met the inclusion criteria. Proportions were combined by means of a random-effects model. Failure-time data were pooled with and pooled without adjustment for differences in case mix. RESULTS: The immediate technical success rate in the PTA group was 91%; the rate was higher in the stent group (96%), but the difference was not statistically significant [corrected]. Complication and mortality rates were not statistically significantly different. Analyzed data included technical failures and were adjusted for lesion type and disease severity. Four-year primary patency rates were 65% for stenoses versus 54% for occlusions after PTA to treat claudication and were 53% for stenoses versus 44% for occlusions after PTA to treat critical ischemia. These rates were 77% for stenoses versus 61% for occlusions after stent placement to treat claudication and 67% for stenoses versus 53% for occlusions after stent placement to treat critical ischemia. The risk of long-term failure was reduced by 39% after stent placement compared with PTA. CONCLUSION: Stent placement and PTA yielded similar complication rates, but the technical success rate was higher after stent placement and the risk of long-term failure was reduced.