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Endovascular stents for intermittent claudicationBachoo P, Thorpe PA
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SummaryEndovascular stents for intermittent claudicationIntermittent claudication is cramping pain in the legs when walking. It is a symptom of atherosclerosis (fatty deposits blocking blood flow though the arteries), causing inadequate blood flow to the leg muscles. Treatments include stopping smoking, exercise, drugs, heart bypass surgery or angioplasty. Angioplasty involves expanding the narrowed artery. It can be done with a 'balloon' inside the artery, and sometimes stents (thin metal sleeves) can be inserted inside the artery to keep it open. The review found there is not enough evidence from trials about the effects of using stents with angioplasty over angioplasty alone to treat intermittent claudication.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 4, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
January 20. 2003 AbstractBackgroundEndovascular stents have been suggested as a means to improve the patency of arteries after angioplasty in patients with intermittent claudication. ObjectivesThe null hypothesis to be tested by this review is that for individuals with claudication, the use of an endovascular stent in addition to percutaneous transluminal angioplasty, does not improve symptoms of life-style limiting claudication, when compared to percutaneous angioplasty alone. Search strategyThe Cochrane Peripheral Vascular Diseases Group searched their Specialised Register, (last searched October 2002), and the Cochrane Central Register of Controlled Trials (CENTRAL), (last searched Issue 3, 2002). We also searched MEDLINE and EMBASE (up to and including January 2001); bibliographies of published data, and hand searched the Journal of Vascular Interventional Radiology (1990-2001). Enquiries were made to stent manufacturers for unpublished trial data. Selection criteriaRandomised trials comparing angioplasty alone, versus angioplasty with endovascular stents, in subjects with intermittent claudication. Data collection and analysisBoth authors independently assessed trial quality and extracted the data. Only published trial data were used. Effectiveness was measured by pre-defined primary outcome measures: restenosis / reocclusion rates and maximum walking distance. Main resultsTwo trials were included with a total sample size of 104 subjects. Both trials included only individuals with femoro-popliteal disease and compared angioplasty and stenting with the Palmaz stent against angioplasty alone. Although one study showed a slight statistical advantage in arterial patency after angioplasty alone, this was not found when the two studies were combined. No differences in the secondary outcomes in either study were detected. Authors' conclusionsThe small number of relevant trials identified, together with the small sample sizes and methodological weaknesses, severely limit the usefulness of this review in guiding practice. Larger multicentre trials are needed. |