Abstract：
OBJECTIVE: With the development of endovascular therapies, some studies have indicated a therapeutic potential for infrapopliteal arterial revascularization with atherectomy (AT). This study was designed to perform a meta-analysis to investigate the efficacy of AT combined with percutaneous transluminal angioplasty (PTA) or drug-coated balloon (DCB) compared with PTA or DCB for infrapopliteal arterial diseases.
METHODS: This is a systematic review and meta-analysis. The Pubmed, Web of Science, and Cochrane Library were systematically searched for articles published up to November 2022, reporting using atherectomy devices for infrapopliteal arterial patients. Randomized controlled trials and retrospective studies were included, and clinical characteristic outcomes were extracted and pooled. Then, we analyzed the efficacies of the AT (AT + PTA or DCB) group and the non-AT (DCB or PTA) group for infrapopliteal arterial patients.
RESULTS: We identified 6 studies with 1269 patients included in this meta-analysis. The risk ratios (RRs) of primary patency for patients treated with atherectomy group compared to non-atherectomy group at 6 months was 1.03 (95% confidence intervals (CIs) 0.86-1.23, p = .74), at 12 months was 1.05 (95% CIs 0.84-1.30, p = .66), in the subgroup analysis between AT combined with DCB and DCB alone, the RRs of primary patency was 1.56 (95% CIs 1.02-2.39, p = .04). The RRs of freedom from target lesion revascularization (TLR) at 6 months was 1.04 (95% CIs 0.93-1.17, p = .45), at 12 months was 1.20 (95% CIs 0.83-1.75, p = .33). The RRs of mortality at 6 months was 0.57 (95% CIs 0.29-1.11, p = .10), and at 12 months was 0.79 (95% CI 0.50-1.25, p = .31). The RRs of limb salvage at 12 months was 0.99 (95% CIs 0.92-1.07, p = .87). The standardized mean difference (SMD) of (Ankle-brachial index) ABI at 12 months was 0.16 (95% CIs 0.06-0.26, p = .001).
CONCLUSIONS: According to this systematic review and meta-analysis, no significant advantages were found with the addition of atherectomy to balloon angioplasty in the below-the-knee segment. Only in the analysis of a small subgroup of atherectomy + DCB versus DCB alone was the primary patency rate at six months significantly higher when adding atherectomy. No further significant differences were found related to 12 months of primary patency, TLR, limb salvage, and mortality among groups.
METHODS: This is a systematic review and meta-analysis. The Pubmed, Web of Science, and Cochrane Library were systematically searched for articles published up to November 2022, reporting using atherectomy devices for infrapopliteal arterial patients. Randomized controlled trials and retrospective studies were included, and clinical characteristic outcomes were extracted and pooled. Then, we analyzed the efficacies of the AT (AT + PTA or DCB) group and the non-AT (DCB or PTA) group for infrapopliteal arterial patients.
RESULTS: We identified 6 studies with 1269 patients included in this meta-analysis. The risk ratios (RRs) of primary patency for patients treated with atherectomy group compared to non-atherectomy group at 6 months was 1.03 (95% confidence intervals (CIs) 0.86-1.23, p = .74), at 12 months was 1.05 (95% CIs 0.84-1.30, p = .66), in the subgroup analysis between AT combined with DCB and DCB alone, the RRs of primary patency was 1.56 (95% CIs 1.02-2.39, p = .04). The RRs of freedom from target lesion revascularization (TLR) at 6 months was 1.04 (95% CIs 0.93-1.17, p = .45), at 12 months was 1.20 (95% CIs 0.83-1.75, p = .33). The RRs of mortality at 6 months was 0.57 (95% CIs 0.29-1.11, p = .10), and at 12 months was 0.79 (95% CI 0.50-1.25, p = .31). The RRs of limb salvage at 12 months was 0.99 (95% CIs 0.92-1.07, p = .87). The standardized mean difference (SMD) of (Ankle-brachial index) ABI at 12 months was 0.16 (95% CIs 0.06-0.26, p = .001).
CONCLUSIONS: According to this systematic review and meta-analysis, no significant advantages were found with the addition of atherectomy to balloon angioplasty in the below-the-knee segment. Only in the analysis of a small subgroup of atherectomy + DCB versus DCB alone was the primary patency rate at six months significantly higher when adding atherectomy. No further significant differences were found related to 12 months of primary patency, TLR, limb salvage, and mortality among groups.
摘要：
目的：随着血管内治疗的发展，一些研究表明,斑块切除术(AT)治疗膝下动脉血运重建具有潜在的治疗价值.本研究旨在进行一项荟萃分析，以研究AT联合经皮腔内血管成形术（PTA）或药物涂层球囊（DCB）与PTA或DCB相比，治疗膝下动脉疾病的疗效。
方法：这是一项系统综述和荟萃分析。Pubmed,WebofScience,和CochraneLibrary系统检索了截至2022年11月发表的文章,报道了使用动脉粥样硬化切除装置治疗膝下动脉患者的情况.纳入随机对照试验和回顾性研究，和临床特征结局被提取并合并.然后，我们分析了AT(AT+PTA或DCB)组和非AT(DCB或PTA)组对膝下动脉患者的疗效.
结果：我们确定了6项研究，1269名患者纳入了该荟萃分析。6个月时，斑块切除术组与非斑块切除术组患者的初次通畅风险比（RR）为1.03（95％置信区间（CI）0.86-1.23，p=0.74），12个月时为1.05（95%CI=0.84-1.30，p=.66），在AT联合DCB和单独DCB之间的亚组分析中，原发性通畅的RR为1.56(95%CI=1.02-2.39，p=.04)。6个月时无靶病变血运重建(TLR)的RR为1.04(95%CI=0.93-1.17,p=.45),12个月时为1.20（95%CI=0.83-1.75，p=0.33）。6个月死亡率的RR为0.57(95%CI=0.29-1.11，p=.10)，12个月时为0.79（95%CI0.50-1.25，p=0.31）。12个月时保肢的RR为0.99（95％CI=0.92-1.07，p=0.87）。12个月时（踝臂指数）ABI的标准化平均差（SMD）为0.16（95％CI=0.06-0.26，p=0.001）。
结论：根据本系统综述和荟萃分析，在膝下段球囊血管成形术中加入斑块切除术并没有显著优势.仅在对小亚组的粥样斑块切除术+DCB与单独DCB的分析中，当添加粥样斑块切除术时，六个月的主要通畅率明显更高。没有发现与12个月的原发性通畅有关的进一步显着差异，TLR,肢体抢救,以及群体间的死亡率。
方法：这是一项系统综述和荟萃分析。Pubmed,WebofScience,和CochraneLibrary系统检索了截至2022年11月发表的文章,报道了使用动脉粥样硬化切除装置治疗膝下动脉患者的情况.纳入随机对照试验和回顾性研究，和临床特征结局被提取并合并.然后，我们分析了AT(AT+PTA或DCB)组和非AT(DCB或PTA)组对膝下动脉患者的疗效.
结果：我们确定了6项研究，1269名患者纳入了该荟萃分析。6个月时，斑块切除术组与非斑块切除术组患者的初次通畅风险比（RR）为1.03（95％置信区间（CI）0.86-1.23，p=0.74），12个月时为1.05（95%CI=0.84-1.30，p=.66），在AT联合DCB和单独DCB之间的亚组分析中，原发性通畅的RR为1.56(95%CI=1.02-2.39，p=.04)。6个月时无靶病变血运重建(TLR)的RR为1.04(95%CI=0.93-1.17,p=.45),12个月时为1.20（95%CI=0.83-1.75，p=0.33）。6个月死亡率的RR为0.57(95%CI=0.29-1.11，p=.10)，12个月时为0.79（95%CI0.50-1.25，p=0.31）。12个月时保肢的RR为0.99（95％CI=0.92-1.07，p=0.87）。12个月时（踝臂指数）ABI的标准化平均差（SMD）为0.16（95％CI=0.06-0.26，p=0.001）。
结论：根据本系统综述和荟萃分析，在膝下段球囊血管成形术中加入斑块切除术并没有显著优势.仅在对小亚组的粥样斑块切除术+DCB与单独DCB的分析中，当添加粥样斑块切除术时，六个月的主要通畅率明显更高。没有发现与12个月的原发性通畅有关的进一步显着差异，TLR,肢体抢救,以及群体间的死亡率。
