LONG-TERM COMPARATIVE EFFECTIVENESS OF ENDOVASCULAR INTERVENTIONS FOR PERIPHERAL ARTERY DISEASE: A NETWORK META-ANALYSIS
Author(s)
Abimbola O. Williams, MPH, MS1, Ifediba Nzube, MBBS, MS2, Luis Filipe, PhD1, Katharina Janke, PhD1.
1Lancaster University, Lancaster, United Kingdom, 2The Life You Can Save, Novato, CA, USA.
1Lancaster University, Lancaster, United Kingdom, 2The Life You Can Save, Novato, CA, USA.
OBJECTIVES: Endovascular interventions are widely used for peripheral artery disease (PAD), but their long-term comparative effectiveness in above-the-knee (ATK) PAD is unclear. This study compared drug-coated balloons (DCB), drug-eluting stents (DES), bare-metal stents (BMS) with percutaneous transluminal angioplasty (PTA) for target lesion revascularization (TLR) and vessel patency in ATK PAD.
METHODS: A systematic review and frequentist random-effects network meta-analysis of randomized controlled trials (RCTs) in ATK PAD was conducted. Medline, Embase, CINAHL, Cochrane, and INAHTA databases were searched from inception. Eligible trials compared DCB, DES or BMS with PTA and reported TLR and/or patency at ≥1 year. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for each timepoint.
RESULTS: Thirty-three RCTs were included. At 1 year, all devices reduced TLR versus PTA: DCB (OR 0.27; 95% CI 0.19-0.38), BMS (0.28; 0.14-0.56), and DES (0.30; 0.14-0.62). Patency was higher with DES (3.81; 2.21-6.57), DCB (3.58; 2.70-4.73), and BMS (2.40; 1.43-4.01). At 2 years, TLR reductions persisted: BMS (0.31; 0.16-0.62), DES (0.34; 0.16-0.71), and DCB (0.42; 0.27-0.67), with sustained patency benefits: DCB (3.02; 2.37-3.85), (DES (2.93; 1.91-4.49), and BMS (2.34; 1.42-3.86). At 3 years, TLR benefits remained DES (0.33; 0.14-0.75), BMS (0.43; 0.18-1.04), and DCB (0.50; 0.25-0.97). Patency advantages persisted: DES (3.01; 1.79-5.07), BMS (2.67; 1.09-6.54), and DCB (2.37; 1.67-3.35). At 5 years, TLR remained lower for DCB (OR 0.51; 0.33-0.77) and DES (0.43; 0.21-0.90) versus PTA, with long-term patency benefits observed for DES; BMS data were unavailable at this horizon.
CONCLUSIONS: DCB and DES provide durable TLR reductions and sustained patency versus PTA, while BMS early benefits attenuate by 3 years. These findings can inform device selection and treatment strategies aimed at optimizing vessel durability.
METHODS: A systematic review and frequentist random-effects network meta-analysis of randomized controlled trials (RCTs) in ATK PAD was conducted. Medline, Embase, CINAHL, Cochrane, and INAHTA databases were searched from inception. Eligible trials compared DCB, DES or BMS with PTA and reported TLR and/or patency at ≥1 year. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for each timepoint.
RESULTS: Thirty-three RCTs were included. At 1 year, all devices reduced TLR versus PTA: DCB (OR 0.27; 95% CI 0.19-0.38), BMS (0.28; 0.14-0.56), and DES (0.30; 0.14-0.62). Patency was higher with DES (3.81; 2.21-6.57), DCB (3.58; 2.70-4.73), and BMS (2.40; 1.43-4.01). At 2 years, TLR reductions persisted: BMS (0.31; 0.16-0.62), DES (0.34; 0.16-0.71), and DCB (0.42; 0.27-0.67), with sustained patency benefits: DCB (3.02; 2.37-3.85), (DES (2.93; 1.91-4.49), and BMS (2.34; 1.42-3.86). At 3 years, TLR benefits remained DES (0.33; 0.14-0.75), BMS (0.43; 0.18-1.04), and DCB (0.50; 0.25-0.97). Patency advantages persisted: DES (3.01; 1.79-5.07), BMS (2.67; 1.09-6.54), and DCB (2.37; 1.67-3.35). At 5 years, TLR remained lower for DCB (OR 0.51; 0.33-0.77) and DES (0.43; 0.21-0.90) versus PTA, with long-term patency benefits observed for DES; BMS data were unavailable at this horizon.
CONCLUSIONS: DCB and DES provide durable TLR reductions and sustained patency versus PTA, while BMS early benefits attenuate by 3 years. These findings can inform device selection and treatment strategies aimed at optimizing vessel durability.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
MT31
Topic
Medical Technologies
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)