Efficacy Of Different Endovascular Treatments For Femoropopliteal Artery In-stent Restenosis (FP-ISR)-A Network Meta-analysis

Background:Currently,although there are various endovascular treatments modalities for femopopliteal artery in-stent restenosis(FP-ISR),it is still unknow which is the best.Objective: To compare the efficacy of different endovascular treatments modalities for femoropopliteal artery stent restenosis(FP-ISR)by network meta-analysis.Methods:The Pub Med,Embase and Register of Controlled Trials(Central)databases were systematically searched on Sep 01,2020,for randomized controlled trails of the treatment of femoropopliteal artery in-stent restenosis.A total of 8 studies involving 800 patients were included.Four endovascular treatments modatilies(ie plain old balloon angioplasty(POBA),cutting balloon angioplasty(CBA),drug coated balloon and laser atherectomy+POBA(LA+POBA))were compared.The rate of recurrent ISR and TLR at6 months and 12 months were used to evaluate their effectiveness.Results:(1)The rate of recurrent ISR: The rate of recurrent ISR at 6 month was significantly lower in DCB group[RR 0.40,95%CI(0.22,0.72)] than in POBA group;The rate of recurrent ISR at12 months was significantly lower in DCB group[RR 0.44,95%CI(0.25,0.75)] than POBA.Other pairwise comparison has no significant difference.(2)The rate of TLR:The rate of TLR at 6 month was significantly lower in LA+POBA [RR 0.57,95%CI(0.37,0.88)] or DCB group[RR 0.31,95%CI(0.15,0.65)] than POBA.The rate of TLR at 12 month was significantly lower in DCB group[RR 0.36,95%CI(0.22,0.58)] than POBA.Other pairwise comparison has no significant difference.(3)The rank probability of rate of recurrent ISR at 6 month:POBA>CBA>LA+POBA>DCB;The rank probability of rate of recurrent ISR at 12 month and rate of TLR at 6,12 month:POBA>LA+POBA>DCB.Conclusion: Among POBA,CBA,DCB and LA+POBA,DCB has the best therapeutic effect on FP-ISR in the current RCTs.