Meta-analysis of Comparative Studies Between Self- and Balloon-Expandable Bridging Stent Grafts in Branched Endovascular Aneurysm Repair

Abstract

Purpose: Currently there is no robust evidence which type of bridging stent graft provides better outcomes after branched endovascular aortic repair (BEVAR). Self-expanding (SESG) and balloon-expandable (BESG) stent grafts are both commonly used to connect branches to their respective target vessels (TV). The aim of the current review was to evaluate the impact of the type of bridging stent grafts on TV outcomes during the mid-term follow-up after BEVAR. Materials and Methods: The study protocol was registered to the PROSPERO (CRD42021274766). A search of the English literature was conducted, using PubMed and EMBASE databases via Ovid and Cochrane database via CENTRAL, from inception to June 30, 2021, using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Only comparative studies on BEVAR reporting TV outcomes related to BESG vs SESG were considered eligible. Individual studies were assessed for risk of bias using the Newcastle Ottawa Scale. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was used to evaluate the quality of evidence. The primary outcomes were primary patency, freedom from endoleak, TV instability, and re-intervention between BESG and SESG, used as bridging stents in branches. The outcomes were summarized as odds ratio along with their 95% confidence intervals (CI), through a paired meta-analysis. Results: Five out of 609 articles published from 2016 to 2020 were included in the analysis. In total, 1406 TV were revascularized, 547 (38.9 %) with BESGs and 859 with SESGs. The overall pooled primary patency (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.29–1.09; p=.256, I2=4.24%) and freedom from branch-related endoleak (OR, 0.65; 95% CI, 0.17–1.48; p<.122, I2=0.18%) did not differ between the stent types during the available follow-up (17 months, range = 12–35 months). In 4 studies (619 TV), SESG required fewer secondary interventions (OR, 1.04; 95% CI, 0.23–1.83; p=.009, I2=0%) and TV instability rate was lower (OR, 0.99; 95% CI, 0.33–1.65; p=.003, I2=0%) compared with BESG during the available follow-up. Conclusion: BESG and SESG seem to perform similarly in terms of primary patency and branch-related endoleak during the mid-term follow-up. Current data from retrospective studies suggest that overall TV instability and re-intervention rates are favorable for SESG as bridging stent grafts in BEVAR.

Midterm results on a new self-expandable covered stent combined with branched stent grafts: Insights from a multicenter Italian registry

“…found comparable primary and secondary rates between self-and balloon-expandable covered stent grafts. 23 In the present study, the patency rates at 1 and 2 years of 98% and 97%, respectively, are in line with previous publications on the same stent graft. 10,11 A lower patency rate at follow-up was recorded when comparing renal vs visceral vessels (P ¼ .042) (Figs 2 and 3).…”

“…Relining stents. The need for adjunctive stent placement in the present cohort reached 40%, in line with the current literature 8,23 ; 50% were placed prophylactically according to the operator's judgement in absence of actual acute angles, dissection, or any other discernable deployment problem. Although conflicting data exists regarding the role of relining, 8,24 in the present series the use of a bare metal balloon-expandable for intrastent relining had a lower patency rate at follow-up.…”

“…Currently available literature has shown that both selfand balloon-expandable covered stents can be applied safely and effectively during BEVAR, and a recent metaanalysis confirms the primary patency and endoleak rates of the literature for both stent types. 23 However, further investigations are needed on the role of relining and its impact on patency. Self-expandable stent grafts, in previous reports, have all been relined using bare metal stents and provided a high patency rate.…”

Comparison of Immediate, Medium, and Long-Term Postoperative Results of Open Surgery and Fenestrated/Branched Stent Grafts for Extended Thoracoabdominal Aortic Aneurysms

“…Data on the mid-term fate of target and visceral vessels have been reported by multicentric studies [90][91][92][93][94][95]. Estimated rates at 5 years of freedom from target artery instability have been evaluated at around 85-90%.…”

Fenestrierte und verzweigte endovaskuläre Aortenprothesen

“…Neben diesen ballonexpandierbaren Stents stellen Gore und Bard auch selbstexpandierbare Stents her. Rezente Analysen zeigen keinen signifikanten Unterschied zwischen selbstexpandierenden und ballonexpandierenden Stents in Bezug auf Undichtigkeiten im Sinne von Typ-3-Endoleaks [ 19 ].…”