A meta-analysis of combined proximal stent grafting with or without adjunctive distal bare stent for the management of aortic dissection.

Abstract Background The efficacy and safety of combined proximal covered stent-grafting with distal bare stenting are controversial because of the lack of evidence. This systematic review and meta-analysis compares the outcomes of combined proximal covered stent-grafting with those of distal bare stenting (BS group) and proximal covered stent-grafting without distal bare stenting (non-BS group). Methods The MEDLINE, EMBASE, and Cochrane Central Register for Controlled Trials databases and key references were searched up to 26 January 2019. Predefined outcomes of interest were mortality, morbidity, and postoperative assessment of aortic remodeling.. We pooled Risk ratios (RRs) of the outcomes of interest using fixed-effects model or random-effects model. Results Overall, 8 observational studies involving 914 patients were included. There were no significant differences in overall aortic-related mortality (RR, 0.54; CI, 0.24-1.24; P=0.15), the complete thoracic false lumen (FL) thrombosis rate (RR, 1.23; CI, 0.83-1.81; P=0.30) or the complete abdominal FL thrombosis rate (RR, 1.96; CI, 0.68-5.69; P=0.21) between the BS group and the non-BS group. The BS group had a lower rate of partial thoracic FL thrombosis (RR, 0.40; CI, 0.25-0.65; P=0.0002), a lower stent-graft-induced new entry (SINE) rate (RR, 0.08; CI, 0.02-0.41; P=0.003) and a lower reintervention rate (RR, 0.42; CI, 0.26-0.69; P=0.0005). Conclusions Combined proximal covered stent-grafting with distal adjunctive bare stenting had the potential to reduce the partial thoracic FL thrombosis rate and the rates of SINE and reintervention but was not associated with lower aortic-related mortality or the complete FL thrombosis rate. Further research with a stricter methodology is needed.