Intravascular ultrasound versus angiography for lower-extremity peripheral artery disease endovascular revascularization: A systematic review and meta-analysis.
Marc-André d'Entremont, Graham R McClure, Krzysztof Kowalik et al.
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In 30 seconds
This systematic review and meta-analysis compared intravascular ultrasound (IVUS) with angiography guidance for endovascular revascularization in peripheral artery disease, analyzing randomized trials separately from observational studies. Two randomized trials (n = 387) found that IVUS guidance likely reduced restenosis (RR, 0.59; 95% CI, 0.42-0.83; moderate certainty). Randomized evidence did not establish reductions in reintervention or mortality, and the effect on major amputation was very uncertain. Observational studies suggested benefits across these outcomes, but certainty was low.
Key findings
- In randomized trials, IVUS likely reduced restenosis versus angiography (RR, 0.59; 95% CI, 0.42-0.83; moderate certainty).
- Randomized evidence did not establish reduced reintervention (RR, 0.68; 95% CI, 0.44-1.08) or mortality (RR, 1.13; 95% CI, 0.37-3.42).
- Observational studies suggested lower restenosis, reintervention, major amputation, and mortality with IVUS, with low certainty for each outcome.
Why it matters
Restenosis after peripheral endovascular revascularization can prompt further intervention, so the randomized signal favoring IVUS is clinically relevant. However, the evidence does not yet show clear randomized benefits for reintervention, mortality, or major amputation. Distinguishing randomized from observational findings helps clinicians interpret the broader apparent benefits without overstating their certainty.
What to keep in mind
Randomized evidence came from only two trials, and the review reports low or very low certainty for several outcomes. Observational findings may not establish that IVUS caused the apparent benefits.