A systematic review and study-level meta-analysis investigating the association between pre-endovascular intervention C-reactive protein levels and femoropopliteal artery restenosis

INTRODUCTION: Restenosis in previously treated femoral or popliteal arteries remains a clinical issue, leading to repeat procedures, and major adverse limb events. Elevated pre-endovascular intervention levels of C-reactive protein (CRP), a marker of systemic inflammation, have previously been associated with coronary restenosis, however, its association with femoropopliteal artery restenosis is unclear. We conducted a systematic review and study-level meta-analysis to assess the association between pre-endovascular intervention CRP levels and femoropopliteal artery restenosis. METHODS: , 2025. A Z-test using a random effects model was used to pool study-level results to obtain pooled standardized mean differences (SMD) and its 95% confidence intervals (CI). A p value of <0.05 indicated statistical significance. RESULTS: After screening a total of 331 unique articles, 14 studies, including 2,097 patients (562 restenosis cases/1,535 no-restenosis controls) were available for quantitative synthesis. Pooled results suggested a significant association between higher pre-endovascular intervention CRP levels and femoropopliteal artery restenosis. (SMD= 0.44, 95% Cl, 0.09-0.78, p= 0.01). There was no evidence of publication bias, both visually via Begg's funnel plot and statistically via Egger's test results (p= 0.52). Leave-one-out sensitivity analysis supported the robustness of the pooled results. CONCLUSIONS: This systematic review and study-level meta-analysis suggests a significant association between higher pre-endovascular intervention CRP levels and the subsequent development of femoropopliteal artery restenosis. Our findings should be interpreted with caution and further large-scale prospective investigations are warranted to substantiate our results.