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Endovascular stent-graft placement in aortic dissection: a meta-analysis Eggebrecht H; Nienaber CA; Neuhauser M; Baumgart D; Kische S; Schmermund A; Herold U; Rehders TC; Jakob HG; Erbel REur Heart J 2006[Feb]; 27 (4): 489-98AIMS: 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 >or=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.|*Blood Vessel Prosthesis Implantation[MESH]|*Stents[MESH]|Acute Disease[MESH]|Angioscopy/*methods[MESH]|Aortic Aneurysm, Thoracic/*surgery[MESH]|Aortic Dissection/*surgery[MESH]|Chronic Disease[MESH]|Clinical Competence/standards[MESH]|Data Collection[MESH]|Female[MESH]|Follow-Up Studies[MESH]|Hospitalization/statistics & numerical data[MESH]|Humans[MESH]|Male[MESH]|Survival Analysis[MESH]|Treatment Outcome[MESH] |
