Drug-coated balloon versus plain old balloon angioplasty in femoropopliteal disease: An updated meta-analysis of randomized controlled trials

Mahesh Anantha Narayanan, Samit M. Shah, Qurat Ul Ain Jelani, Santiago Garcia, Costin Ionescu, Christopher Regan, Carlos Mena-Hurtado

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

Background: Drug-coated balloon (DCB) angioplasty has emerged as a mainstay of therapy for the treatment of peripheral arterial disease (PAD) involving the superficial femoral and popliteal arteries. We performed a meta-analysis including all available randomized controlled trials (RCTs) to date which compare DCB to plain balloon angioplasty (POBA) in femoropopliteal disease (FPD). Methods: Five databases were analyzed including EMBASE, PubMed, Cochrane, Scopus, and Web-of-Science from January 2000 to September 2018 for RCTs comparing DCB to POBA in patients with FPD. Heterogeneity was determined using Cochrane's Q-statistics. Random effects model was used. Results: Twenty-two RCTs, including five trials of in-stent restenosis (ISR) intervention, with 3,217 patients were included in the analysis. Mean follow-up was approximately 21.6 ± 14.4 months. Overall, DCB use was associated with a 51% reduction in target vessel revascularization (TLR) when compared to POBA at follow-up (relative risk [RR]: 0.49, 95% confidence interval [CI]: 0.40–0.61, P < 0.0001). Rates of TLR were 45% lower in the DCB group when compared to POBA in patients with ISR (RR: 0.55, 95% CI: 0.37–0.81, P = 0.002). DCB was associated with lower rates of binary stenosis, late lumen loss and higher primary safety endpoints. Major amputation and mortality were not different between DCB and POBA. Conclusions: Use of DCBs is associated with improved vessel patency and a lower risk of TLR when compared to POBA in patients with FPD, especially in the setting of ISR. There was no difference in mortality between DCB and POBA in our meta-analysis. Extended follow-up of the available RCT data will be essential to analyze long-term device-related mortality.

Original languageEnglish (US)
Pages (from-to)139-148
Number of pages10
JournalCatheterization and Cardiovascular Interventions
Volume94
Issue number1
DOIs
StatePublished - Jul 1 2019

Bibliographical note

Funding Information:
Dr Carlos Mena is a consultant for Cook. Dr Garcia is a consultant for Surmodics, Osprey medical, Medtronic, Edwards Lifesciences, Abbott and Boston Scientific. Dr Garcia has research grants from Research grants from Edwards Life Sciences, Minnesota Veterans Research Foundation, and VA Office of Research and Development. Dr Regan is a consultant for Medtronic.

Publisher Copyright:
© 2019 Wiley Periodicals, Inc.

Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.

Keywords

  • drug-coated balloon
  • femoropopliteal disease
  • peripheral arterial disease

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