Angioplasty versus stenting for superficial femoral artery lesions

Background Lower limb peripheral arterial disease (PAD) is a common, important manifestation of systemic atherosclerosis. Stenoses or occlusions in the superficial femoral artery may result in intermittent claudication as an early consequence, which may be treated by balloon angioplasty with or without stenting. Objectives The objective was to determine the effect of percutaneous transluminal angioplasty (PTA) when compared with PTA with stenting for lesions of the superficial femoral artery, for people with intermittent claudication or critical limb ischaemia. Search strategy The Cochrane Peripheral Vascular Diseases (PVD) Group searched their trials register (last searched February 2009) and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2009, Issue 1) for publications describing randomised controlled trials (RCTs) of percutaneous angioplasty with or without stenting. Selection criteria Randomised trials of angioplasty alone versus angioplasty with stenting for the treatment of superficial femoral artery stenoses. Data collection and analysis Two authors (CT, JC) independently selected suitable trials, assessed trial quality and extracted data. A third author (AS) ranked the concealment of allocation and checked the final manuscript. The fourth author (DM) cross checked all stages of the review process. Main results Eight trials with 968 participants were included. The average age was 67 and all trials included men and women. Participants were followed for up to two years. There was a small but statistically significant improvement in primary angiographic and duplex patency at six months in patients treated with PTA plus stent over lesions treated with PTA alone (three trials and four trials, respectively). However, primary angiographic patency was non-significant 12 months (five trials, P = 0.23) and 24 months (two trials, P = 0.45). A similar but lesser effect was seen for ankle brachial pressure index (ABPI), while a more pronounced improvement in treadmill walking distance in patients with PTA plus stent insertion was observed at six and 12 (P < 0.0001), but not 24 months (P = 0.81). Only one trial reported quality of life, which showed no significant difference between patients treated with PTA alone or PTA with stent insertion at any time interval. Antiplatelet therapy protocols and inclusion criteria between trials showed marked heterogenicity. Authors' conclusions There is limited benefit to stenting lesions of the superficial femoral artery in addition to angioplasty, however this cannot be recommended routinely based on the results of this analysis.