Objectives The aim of this study was to analyze the technical success and long-term patency of the endovascular treatment of TransAtlantic Inter-Society Consensus (TASC) C and D aorto-iliac arterial ...lesions. Methods All studies reporting original series of patients published in English between 2000 and 2010 were enrolled into meta-analysis. Separate meta-analyses were performed for groups with immediate technical success, 12-month patency, and long-term outcomes. Subgroup analyses were performed to determine if there were differences in outcomes between patients with varying types of lesions (TASC C or D lesions) or between different stenting strategies, including primary or selective stenting. Results Sixteen articles consisting of 958 patients were enrolled in this meta-analysis. The pooled estimate for technical success was 92.8% (95% confidence interval CI, 89.8%-95.0%, 749 cases). Primary patency at 12 months was 88.7% (95% CI, 85.9%-91.0%, 787 cases). Subgroup analyses demonstrated a technical success rate of 93.7% (95% CI, 88.9%-96.5%) and a 12-month primary patency rate of 89.6% (95% CI, 84.8%-93.0%) for TASC C lesions. For TASC D lesions, these rates were 90.1% (95% CI, 76.6%-96.2%) and 87.3% (95% CI, 82.5%-90.9%), respectively. The technical success and 12-month primary patency rates for primary stenting were 94.2% (95% CI, 91.8%-95.9%) and 92.1% (95% CI, 89.0%-94.3%), respectively; for selective stenting, these rates were 88.0% (95% CI, 67.9%-96.2%) and 82.9% (95% CI, 72.2%-90.0%), respectively. The long-term, primary patency rates for patients receiving primary stenting were significantly better than those receiving selective stenting. Publication bias was not significant for these analyses. Conclusions This study demonstrates that early and midterm outcomes of endovascular treatment for TASC C and D aorto-iliac lesions were acceptable, with a better patency for primary stenting than selective stenting.
...stenting (via the transaortic route) causes more procedural stroke, death, and heart attacks than does carotid endarterectomy, and patients tend to live long-term with those strokes.2 Furthermore, ...all strokes should be considered disabling unless proven otherwise.2 Second, there are no randomised trials of transcarotid artery revascularisation. ...a clinical indication for transcarotid arterial revascularisation is unproven.2 Third, there is no randomised trial evidence of patient benefit from any carotid artery procedure compared with current standards of non-invasive care alone. Furthermore, non-invasive angiography and routine practice physicians tend to overestimate carotid stenosis severity compared with independent external experts.3–5 Sixth, the proposed CMS reimbursement-dependent shared-decision-making tool is non-existent. ...a tool could not ensure prevention of medical malpractice and patient exploitation, given patients usually default to the information that is provided to (or withheld from) them.2 Lastly, patient outcomes are highly dependent on proceduralist expertise. LS is a retired Medical Officer (2000–13) for the Coverage and Analysis Group, Office of Clinical Standards and Quality, Center for Medicare & Medicaid Services, Baltimore MD, USA; and was Lead Medical Officer for the Medicare Evidence Development & Coverage Advisory Committee, Management of Carotid Atherosclerosis, on Jan 25, 2012.
Behind the Mirror, the Black Box of Registries Ricco, Jean-Baptiste; Thaveau, Fabien
European journal of vascular and endovascular surgery,
February 2022, 2022-02-00, 20220201, Volume:
63, Issue:
2
Journal Article
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