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Intravascular Lithotripsy In Peripheral Arterial Disease - A Pilot Single Arm Meta-analysis
Vinay C Bellur, MBBS
1, Ananya Prasad, MBBS(student)
1, Samyuktha Vinu Nair, MBBS(student)
2, Deepika Reddy, MBBS(student)
2, Sai Nandan Prasad, MBBS(student)
1, Advaith N Rao
1, Disha Prashanth
1, Pranav Sharma
3, Vikram C Bellur
4, Adithya Sathyanarayana
1.
1M S RAMAIAH MEDICAL COLLEGE, Bengaluru, India,
2Bangalore Medical College and Research Institute, Bengaluru, India,
3SHKM Government Medical College, Gehbar, India,
4Kasturba Medical College of Manipal, Manipal, India.
OBJECTIVES:Peripheral arterial diseases require recurrent revascularization therapy due to limited success of current interventional and medical procedures attributed to failure to penetrate the intima and media complex of the vessels. Current procedures, which involve use of drug coated balloons and atherectomy systems, are known to be associated with higher adverse events such as vessel occlusion, dissection, perforation, and distal embolization.
METHODS:The meta-analysis was performed according to the PRISMA guidelines. PubMed, Web of Science and Embase databases were searched. Studies which involved Intravascular Lithotripsy as an intervention for Femoral and Popliteal Atherosclerosis, and included outcomes such as Freedom from Target Revascularisation, improvement of the Rutherford classification of peripheral arterial diseases were included in the meta-analysis.
The statistical analyses were conducted in R studio and were analyzed as Pooled proportions or Pooled mean and standard deviations. The Random intercept logistic regression model and Clopper-Pearson confidence interval for individual studies were used for pooled proportions.
RESULTS:Screening of 404 studies were performed and 6 studies were included to conduct the meta analysis . The total population analyzed was 331 patients.The proportion of freedom from target revascularisation was 0.9500 [95% CI; 0.9174; 0.9702, p = 0.66] both in the common effects model and the random effects model. The improvement in Rutherford's Class was assessed in 189 patients from 3 studies. The random effects model indicated a mean improvement of 1.7758 [95% CI; p <0.001] of Rutherford’s Class upon treatment with intravascular lithotripsy. CONCLUSIONS:
Significant freedom from target revascularisation, improvement of the stenosis and reduced adverse events of the procedure emphasize the impact of Intravascular Lithotripsy as a dependable choice for management of Femoral and Popliteal Atherosclerosis. Further clinical trials comparing different existing management therapies with this procedure and involving a longer follow-up should be conducted to further assess the utility of Intravascular Lithotripsy for the management of Peripheral Arterial Diseases.
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