TY - JOUR
T1 - Pulmonary Vein Stenosis—Balloon Angioplasty Versus Stenting
T2 - A Systematic Review and Meta-Analysis
AU - Almakadma, Abdul Hakim
AU - Sarma, Dhruv
AU - Hassett, Leslie
AU - Miranda, William
AU - Alkhouli, Mohamad
AU - Reeder, Guy S.
AU - Munger, Thomas M.
AU - Packer, Douglas L.
AU - Simard, Trevor
AU - Holmes, David R.
N1 - Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/10
Y1 - 2022/10
N2 - Pulmonary vein stenosis (PVS) may arise from a variety of conditions and result in major morbidity and mortality. In some patients, pharmacologic therapy may help, but more often in advanced stages, mechanical treatment must be considered. Transcatheter approaches, both balloon angioplasty (BA) and stent implantation, have been applied. Although both are effective, they continue to be limited by restenosis. In this systematic review and meta-analysis, Ovid MEDLINE, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus were searched for English-language studies in humans published between January 1, 2010, and August 2, 2021. Two independent reviewers screened for studies in which BA or stenting was performed for PVS with reporting of restenosis outcomes, and data were independently extracted. A systematic review was performed, and overall restenosis rates were reported across all 34 included studies. Meta-analysis was then performed using RevMan version 5.4, assessing rates of restenosis and restenosis requiring reintervention in those studies with available data reported. For restenosis rates, 4 studies treated a total of 340 patients with 579 pulmonary vein interventions (225 with BA and 354 with stenting, mean follow-up 13-69 months). Restenosis requiring repeat intervention was reported in 3 studies, including 301 patients with 495 pulmonary vein interventions (157 with BA and 338 with stenting). Compared with BA, stenting was associated with both a lower risk for restenosis (risk ratio: 0.36; 95% CI: 0.18-0.73; P = 0.005) and a lower risk for restenosis requiring reintervention (RR: 0.36; 95% CI: 0.15-0.86; P = 0.02). For PVS intervention, restenosis and reintervention rates may be improved by stent implantation compared with BA.
AB - Pulmonary vein stenosis (PVS) may arise from a variety of conditions and result in major morbidity and mortality. In some patients, pharmacologic therapy may help, but more often in advanced stages, mechanical treatment must be considered. Transcatheter approaches, both balloon angioplasty (BA) and stent implantation, have been applied. Although both are effective, they continue to be limited by restenosis. In this systematic review and meta-analysis, Ovid MEDLINE, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus were searched for English-language studies in humans published between January 1, 2010, and August 2, 2021. Two independent reviewers screened for studies in which BA or stenting was performed for PVS with reporting of restenosis outcomes, and data were independently extracted. A systematic review was performed, and overall restenosis rates were reported across all 34 included studies. Meta-analysis was then performed using RevMan version 5.4, assessing rates of restenosis and restenosis requiring reintervention in those studies with available data reported. For restenosis rates, 4 studies treated a total of 340 patients with 579 pulmonary vein interventions (225 with BA and 354 with stenting, mean follow-up 13-69 months). Restenosis requiring repeat intervention was reported in 3 studies, including 301 patients with 495 pulmonary vein interventions (157 with BA and 338 with stenting). Compared with BA, stenting was associated with both a lower risk for restenosis (risk ratio: 0.36; 95% CI: 0.18-0.73; P = 0.005) and a lower risk for restenosis requiring reintervention (RR: 0.36; 95% CI: 0.15-0.86; P = 0.02). For PVS intervention, restenosis and reintervention rates may be improved by stent implantation compared with BA.
KW - balloon angiography
KW - cardiac ablation
KW - fibrosing mediastinitis
KW - pulmonary vein stenosis
KW - stenting
UR - http://www.scopus.com/inward/record.url?scp=85138792556&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85138792556&partnerID=8YFLogxK
U2 - 10.1016/j.jacep.2022.08.008
DO - 10.1016/j.jacep.2022.08.008
M3 - Review article
C2 - 36117046
AN - SCOPUS:85138792556
SN - 2405-500X
VL - 8
SP - 1323
EP - 1333
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 10
ER -