Comparing Percutaneous Transluminal Angioplasty and Stent Placement for Treatment of Subclavian Arterial Occlusive Disease: A Systematic Review and Meta-Analysis

Ahmed T. Ahmed, Khaled Mohammed, Monzer Chehab, Waleed Brinjikji, Mohammad H Murad, Harry Cloft, Haraldur Bjarnason

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background and Purpose: Subclavian artery occlusive disease (SAOD) is often associated with cerebrovascular symptoms such as subclavian steal syndrome and stroke. We conducted a systematic review and meta-analysis to compare percutaneous transluminal angioplasty (PTA) and stent placement for the treatment of SAOD. Materials and Methods: We searched Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through October 16, 2014. From each study, we abstracted baseline patient characteristics, study design variables, and outcome data including rates of technical success, primary patency (≤2 and >2 years follow-up), symptom resolution, and complications. Meta-analysis was performed using a random-effects model. Results: A total of 35 non-comparative studies with 1726 patients were included. Technical success rate was significantly higher in the stent group than the PTA group (92.8 vs 86.8 %, p = 0.007). Long-term primary patency rates (76.9 vs 79.6 %, p = 0.729) and symptom resolution rates (82.2 vs 73.0 %, p = 0.327) were not statistically different. There was no statistically significant difference in the rates of stroke or death. Conclusion: Stent placement for treatment of SAOD may be associated with higher rates of technical success but similar rates of symptom resolution and long-term outcomes. The confidence in the available estimates is low. Further comparative studies are needed to guide patients and clinicians in shared decision making.

Original languageEnglish (US)
Pages (from-to)1-16
Number of pages16
JournalCardioVascular and Interventional Radiology
DOIs
StateAccepted/In press - Dec 2 2015

Fingerprint

Arterial Occlusive Diseases
Subclavian Artery
Angioplasty
Stents
Meta-Analysis
Stroke
Subclavian Steal Syndrome
Decision Making
Therapeutics
Databases

Keywords

  • Arterial intervention
  • Diagnostic
  • Endovascular Aneurysm Repair/Endovascular Aortic Repair (EVAR)
  • Endovascular treatment
  • Inferior Vena Cava Filter (IVC) placement
  • Neurointerventions
  • Venous intervention
  • Venous intervention

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Comparing Percutaneous Transluminal Angioplasty and Stent Placement for Treatment of Subclavian Arterial Occlusive Disease : A Systematic Review and Meta-Analysis. / Ahmed, Ahmed T.; Mohammed, Khaled; Chehab, Monzer; Brinjikji, Waleed; Murad, Mohammad H; Cloft, Harry; Bjarnason, Haraldur.

In: CardioVascular and Interventional Radiology, 02.12.2015, p. 1-16.

Research output: Contribution to journalArticle

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abstract = "Background and Purpose: Subclavian artery occlusive disease (SAOD) is often associated with cerebrovascular symptoms such as subclavian steal syndrome and stroke. We conducted a systematic review and meta-analysis to compare percutaneous transluminal angioplasty (PTA) and stent placement for the treatment of SAOD. Materials and Methods: We searched Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through October 16, 2014. From each study, we abstracted baseline patient characteristics, study design variables, and outcome data including rates of technical success, primary patency (≤2 and >2 years follow-up), symptom resolution, and complications. Meta-analysis was performed using a random-effects model. Results: A total of 35 non-comparative studies with 1726 patients were included. Technical success rate was significantly higher in the stent group than the PTA group (92.8 vs 86.8 {\%}, p = 0.007). Long-term primary patency rates (76.9 vs 79.6 {\%}, p = 0.729) and symptom resolution rates (82.2 vs 73.0 {\%}, p = 0.327) were not statistically different. There was no statistically significant difference in the rates of stroke or death. Conclusion: Stent placement for treatment of SAOD may be associated with higher rates of technical success but similar rates of symptom resolution and long-term outcomes. The confidence in the available estimates is low. Further comparative studies are needed to guide patients and clinicians in shared decision making.",
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AU - Brinjikji, Waleed

AU - Murad, Mohammad H

AU - Cloft, Harry

AU - Bjarnason, Haraldur

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AB - Background and Purpose: Subclavian artery occlusive disease (SAOD) is often associated with cerebrovascular symptoms such as subclavian steal syndrome and stroke. We conducted a systematic review and meta-analysis to compare percutaneous transluminal angioplasty (PTA) and stent placement for the treatment of SAOD. Materials and Methods: We searched Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through October 16, 2014. From each study, we abstracted baseline patient characteristics, study design variables, and outcome data including rates of technical success, primary patency (≤2 and >2 years follow-up), symptom resolution, and complications. Meta-analysis was performed using a random-effects model. Results: A total of 35 non-comparative studies with 1726 patients were included. Technical success rate was significantly higher in the stent group than the PTA group (92.8 vs 86.8 %, p = 0.007). Long-term primary patency rates (76.9 vs 79.6 %, p = 0.729) and symptom resolution rates (82.2 vs 73.0 %, p = 0.327) were not statistically different. There was no statistically significant difference in the rates of stroke or death. Conclusion: Stent placement for treatment of SAOD may be associated with higher rates of technical success but similar rates of symptom resolution and long-term outcomes. The confidence in the available estimates is low. Further comparative studies are needed to guide patients and clinicians in shared decision making.

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