Effect of Left Subclavian Artery Revascularisation in Thoracic Endovascular Aortic Repair: A Systematic Review and Meta-analysis.

OBJECTIVE/BACKGROUND: Thoracic endovascular aortic repair (TEVAR) is an emerging therapy for thoracic aortic pathologies. However, the role of left subclavian artery (LSA) revascularisation in patients with LSA coverage in TEVAR has not been established. A systematic review and meta-analysis was done to investigate the effect of LSA revascularisation in TEVAR when the LSA was covered.

METHODS

PubMed, Embase, and the Cochrane Library were searched to find relevant randomised controlled trials (RCTs) and cohort studies. The Cochrane Risk of Bias Tool and Newcastle-Ottawa Scale was used to evaluate the methodological quality of RCTs and cohort studies respectively. Relative risks (RRs) with 95% confidence intervals (CIs) were calculated to express differences for dichotomous outcomes. Random effects models were used to combine outcomes for studies with I > 50%; otherwise, fixed effects models were used. Subgroup analyses and sensitivity analyses were performed to further validate the results.

RESULTS

Sixteen cohort studies with a total of 2591 patients were included in this systematic review and meta-analysis. The average score of the included studies was 7.56. Of the included patients, the peri-operative stroke rate was 6.8% (n = 176/2591). The peri-operative stroke rates of the with and without LSA revascularisation groups were 5.4% and 7.8%, respectively. Compared with no LSA revascularisation, patients with LSA revascularisation had a significantly lower peri-operative stroke rate (RR 0.61; 95% CI 0.45-0.82; I = 20%) and peri-operative spinal cord ischaemia (SCI) rate (RR 0.59; 95% CI 0.39-0.90; I = 0). No significant difference was found between the with and without LSA revascularisation groups with respect to peri-operative mortality (RR 0.86; 95% CI 0.60-1.21; I = 35%) and peri-operative paraplegia (RR 0.81; 95% CI 0.45-1.44; I = 17%).

CONCLUSION

The results of this review reveal that LSA revascularisation was associated with significantly lower peri-operative stroke and SCI rates. LSA revascularisation should be recommended for patients with LSA coverage in TEVAR. High quality RCTs are needed to further validate the conclusion.