Network meta-analysis of balloon angioplasty, nondrug metal stent, drug-eluting balloon, and drug-eluting stent for treatment of infrapopliteal artery occlusive disease

Abstract

C omputed tomography (CT) colonography is a noninvasive method for colorectal carcinoma screening and was shown to be highly sensitive for colorectal cancer and polyp detection in previous studies (1-4). The major problem for diagnostic and screening CT colonography is differentiation of tumor and polyps from stool. Therefore, several methods are used for this purpose such as prone and supine imaging (looking for movement of stool), use of laxatives (to clear stool from colon), barium tagging (to mark stools with barium) and density measurements (5). However, some patients can refuse or cannot tolerate bowel preparation leading to cancellation of CT colonography examinations. For patients who do not tolerate bowel preparation, laxative-free or reduced preparation protocols have been developed. Dual-energy computed tomography (DECT) is becoming increasingly used for body computed tomography (CT) applications (6-8). The major advantage of DECT is its ability to obtain iodine map and virtual noncontrast (VNC) images in a single CT study by acquiring two datasets with different kilovolts. On contrast-enhanced single-energy CT images, the density of a measured area is equal to basal density of the area plus the density increment due to iodine uptake. DECT allows measurement of basal density and the degree of iodine uptake on VNC and iodine map images, respectively, without acquiring unenhanced CT images (9). Pilot studies reported utility of DECT principle for diagnostic CT colonography and electronic cleansing after barium tagging for CT colonography (5, 10, 11). Recent studies showed that colorectal cancer can be detected without bowel preparation by DECT (12) A B D O M I N A L I MAG I N G O R I G I N A L A R T I C L E PURPOSEWe aimed to determine dual-energy computed tomography (DECT) characteristics of colorectal cancer and investigate effectiveness of DECT method in differentiating tumor from stool in patients with colorectal cancer. METHODSFifty consecutive patients with colorectal tumors were enrolled. Staging was performed by DECT (80-140 kV) using dual-source CT after rectal air insufflation and without bowel preparation. Both visual and quantitative analyses were performed at 80 kV and 140 kV, on iodine map and virtual noncontrast (VNC) images. RESULTSAll colorectal tumors had homogeneous pattern on iodine map. Stools demonstrated heterogeneous pattern in 86% (43/50) and homogeneous pattern in 14% (7/50) on iodine maps and were less visible on VNC images. Median density of tumors was 54 HU (18-100 HU) on iodine map and 28 HU (11-56 HU) on VNC images. Median density of stool was 36.5 HU (8-165 HU) on iodine map and -135.5 HU (-438 HU to -13 HU) on VNC images. The density of stools was significantly lower than tumors on both iodine map and VNC images (P < 0.001). The cutoff point of density measurement on VNC images was -1 HU with area under the curve of 1 and a sensitivity and specificity of 100%. CONCLUSIONDensity or visual analysis of iodine map and VNC DECT images allow accurate differentiation of tumor ...

World’s First Experience Treating TASC II C and D Tibial Occlusive Disease Using the Selution SLR Sirolimus-Eluting Balloon: Six-Month Results From the PRESTIGE Study

“… 29 However, there are other meta-analyses that did not show superiority of PCB over CBA in terms of binary restenosis, TLR, and major amputation rates. 30 – 32 Furthermore, Katsanos et al 15 have recently showed a worse 1-year AFS rate following infrapopliteal arteries treated with PCBs, although this meta-analysis has been heavily criticized for use of nonpublished data at the time. AFS was worse in those studies using a higher dose (3.0–3.5 µg/mm 2 ) balloon drug coating and paclitaxel distal embolization was postulated to be the underlying mechanism by the authors.…”

Comparative Effectiveness of Endovascular Treatment Modalities for De Novo Femoropopliteal Lesions: A Network Meta-analysis of Randomized Controlled Trials

“…Network meta-analysis is capable of aggregating the results of RCTs into a single unified analysis that compares three or more interventions while completely respecting randomization. 6,66 The advantages of network meta-analysis are the accuracy of the estimates derived from evidence integration and the accompanying relative ranking of all of the interventions.…”

“…Traditional meta-analytical methods involve only pairwise comparisons between 2 interventions, while network meta-analysis, also known as multiple treatment comparison meta-analysis, can be used for all possible comparisons in a body of evidence regardless of whether direct head-to-head comparisons had been performed in clinical trials. 6 Therefore, a systematic review and network meta-analysis was conducted of all of the available randomized controlled trials (RCTs) that compared the efficacy of multiple treatments with regard to binary restenosis, target lesion revascularization (TLR), mortality, and technical success in the femoropopliteal segment.…”

Gepants for abortive treatment of migraine: A network meta‐analysis

“…α less than 0.05 was set as the significant level. The network meta‐analysis was conducted by Addis v1.16.8 (http://drugis.org/software/addis1/addis1.16) (Cipriani et al, 2009; Dias, Welton, Caldwell, & Ades, 2010; Xiao, Chen, Yang, & Kou, 2016). The software is designed according to the Bayesian hierarchical model and Markov Chain Monte Carlo (MCMC) method.…”