ObjectiveTo evaluate the efficacy and safety of endovascular implantation of bare-metal stent (BMS) and endovascular implantation of drug-eluting stent (DES) in treatment of infrapopliteal arterial occlusive disease by using Meta-analysis. MethodsRandomized controlled trial about endovascular implantation of BMS and endovascular implantation of DES in treatment of infrapopliteal arterial occlusive disease were searched in domestic and international databases, literature screening in accordance with inclusion criteria and exclusion criteria was taken firstly, and then quality assessment was performed. Comparison of 1-year restenosis rate, 1-year patency rate, incidence of limb salvage, mortality, and 1-year target lesion revascularization rate after operation between BMS group and DES group were performed by using RevMan 5.2 software for Meta-analysis. ResultsSix literatures included 572 cases who suffered from infrapopliteal arterial occlusive disease were included at all, including 302 cases in DES group and 270 cases in BMS group. The results of Meta-analysis showed that, compared with BMS group, 1-year patency rate after operation in DES group was higher (OR=1.64, 95% CI:1.35-1.98, P < 0.000 1), but 1-year restenosis rate (OR=0.19, 95% CI:0.12-0.30, P < 0.000 1) and 1-year target lesion revascularization rate after operation (OR=0.09, 95% CI:0.02-0.32, P=0.000 2) were both lower. There were no significance difference between the BMS group and DES group on incidence of postoperative limb salvage (OR=1.29, 95% CI:0.58-2.86, P=0.530 0) and postoperative mortality (OR=0.98, 95% CI:0.58-1.65, P=0.940 0). ConclusionsCompared with endovascular implantation of BMS, endovascular implantation of DES can increase the 1-year patency rate and reduce 1-year restenosis rate or 1-year target lesion revascularization rate after operation for infrapopliteal arterial occlusive disease.
ObjectiveTo assess the efficacy and safety of low-(10 mg) and high-dose (20 mg) of recombinant tissue typeplasminogen activator (rt-PA) catheter-directed thrombolysis for lower limb ischemia by using meta-analysis. MethodsThe literatures of randomized clinical trials (RCT) concerning low-versus high-dose rt-PA catheter-directed thrombolysis for lower limb ischemia study were searched using the national and international electronic databases.The literatures were screened and quality evaluated according to the inclusion and exclusion criteria, and analyzed by using the Cochrane Center the RevMan 5.2 software. ResultsA total of 4 RCT studies, with a total of 360 patients (192 patients in low dose group and 168 patients in high-dose group) were included.No statistical difference were noted in low-versus high-dose group with regard to ankle-brachial index (RR=0.20, 95%CI=-0.43-0.02, P=0.07), 30 days amputation-free survival (RR=1.00, 95%CI=0.94-1.08, P=0.91), 6 months the probability of restenosis (RR=1.00, 95%CI=0.60-1.67, P=1.00), and the incidence of groin hematoma (< 5 cm, RR=1.24, 95%CI=0.56-2.77, P=0.59).But the incidence of bleeding and the incidence of stress ulcer in low-dose group were lower than those in high-dose group (RR=2.38, 95%CI=1.10-5.15, P=0.03;RR=2.49, 95%CI=1.21-5.13, P=0.01). ConclusionTwo doses of rt-PA treatment of limb ischemia similar efficacy, but the incidence of low-dose regimen of complications is significantly lower than the high dose regimen.