Endovascular stent-graft placement in aortic dissection: A meta-analysis

Abstract

Aims: This article summarizes all available published data with respect to clinical success, complications, and outcomes of endovascular stent-graft placement among patients with descending aortic dissection (AD). Methods and results: We performed a meta-analysis of all published series on retrograde endovascular stent-graft placement encompassing ≥3 patients with AD. Thirty-nine studies, involving a total of 609 patients, were included. Procedural success was reported in 98.2 ± 0.5% of patients. Major complications were reported in 11.1 ± 1.4%, with the most dreaded neurologic complications in 2.9 ± 0.7% patients. Periprocedural stroke was encountered more frequently than paraplegia (1.9 ± 0.6% vs. 0.8 ± 0.4%). Overall complications were significantly higher in patients undergoing stent-graft placement for acute AD than in patients with chronic AD (21.7 ± 2.8% vs. 9.1 ± 2.3%, P = 0.005). The overall 30-day mortality was 5.3 ± 0.9%, and was three-fold higher in patients with acute AD when compared with chronic AD (9.8 ± 2.2% vs. 3.2 ± 1.4%, P = 0.015). In addition, 2.8 ± 0.7% of patients died over a mean follow-up period of 19.5 ± 7.1 months. Kaplan-Meier analysis yielded overall survival rates of 90.6 ± 1.6% at 6 months, 89.9 ± 1.7% at 1 year, and 88.8 ± 1.9% at 2 years, respectively. Conclusion: Endovascular stent-graft placement in type B-AD is technically feasible with success rates of >95% in selected cohort. Although minimally invasive, major complications occurred in 14-18% of patients depending upon the acuity of presentation, with very low incidence of paraplegia. Both, acute and mid-term mortality of this novel treatment strategy appear to favourably compare with surgical treatment but further studies are necessary to compare stent-graft placement with medical treatment in uncomplicated AD. © The European Society of Cardiology 2005. All rights reserved.