Department of Cardiac and Thoracic Vascular Surgery, The First People's Hospital of Jiashan County, The Second Affiliated Hospital of Zhejiang University, Jiashan Branch, Jiaxing, Zhejiang, 310051, China.
Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang, University's Medical School, Hangzhou, Zhejiang, 310051, China.
Langenbecks Arch Surg. 2024 Jul 15;409(1):215. doi: 10.1007/s00423-024-03406-9.
Endovascular stent therapy (EST) for spontaneous isolated superior mesenteric artery dissection (SISMAD) is gaining popularity, yet the treatment strategy - BMT or EST - remains debatable.
A meta-analysis examined all randomized trials and observational studies exploring the relative merits and potential risks of EST vs. BMT in treating SISMAD patients. Key outcomes included early and long-term adverse effects, with odds ratios (ORs) and 95% confidence intervals (CI) calculated. A random- or fixed-effects model was selected according to a 50% heterogeneity threshold.
9 observational studies involving a total of 672 SISMAD patients (303 EST), met our selection criteria. We discovered no noteworthy distinctions between the EST group and the BMT group in terms of early symptoms' alleviation, reinterventions, or all-cause mortality. However, patients receiving EST management will be hospitalized longer than those receiving BMT (EST: 13.2 ± 5.1 months vs. BMT: 7.0 ± 2.2 months, P < 0.01). In the long run, EST was found to significantly contribute to a higher rate of complete remodeling (OR: 4.53, CI: 3.01 ~ 6.81, P < 0.01; heterogeneity, I = 50%) and a lower incidence of aneurysm formation (OR: 0.19, CI: 0.06 ~ 0.6, P < 0.01; heterogeneity, I = 0%) than BMT. However, there are no significant differences between ESTand BMTin terms of all-cause mortality, recurrent syndrome, reintervention, and SMA stenosis or occlusion.
EST can effectively prevent the formation of aneurysmal dissection and improve SISMAD remodeling. Both EST and BMT are similar in reducing long-term mortality, recurrent symptoms, severe SMA stenosis or occlusion, and the need for reintervention in patients with SISMAD.
血管内支架治疗（EST）自发性孤立性肠系膜上动脉夹层（SISMAD）越来越受欢迎，但 BMT 与 EST 的治疗策略仍存在争议。
对所有探索 EST 与 BMT 治疗 SISMAD 患者相对优势和潜在风险的随机试验和观察性研究进行了荟萃分析。主要结局包括早期和长期不良事件，计算比值比（OR）和 95%置信区间（CI）。根据 50%异质性阈值选择随机或固定效应模型。
纳入的 9 项观察性研究共纳入 672 例 SISMAD 患者（303 例 EST），符合我们的选择标准。EST 组与 BMT 组在早期症状缓解、再次干预或全因死亡率方面无显著差异。然而，接受 EST 治疗的患者住院时间长于接受 BMT 的患者（EST：13.2±5.1 个月 vs. BMT：7.0±2.2 个月，P<0.01）。长期来看，EST 显著增加完全重塑的发生率（OR：4.53，CI：3.016.81，P<0.01；异质性，I=50%）和降低动脉瘤形成的发生率（OR：0.19，CI：0.060.6，P<0.01；异质性，I=0%），优于 BMT。然而，EST 和 BMT 在全因死亡率、复发综合征、再次干预以及 SMA 狭窄或闭塞方面无显著差异。
EST 能有效预防动脉瘤性夹层的形成，改善 SISMAD 重塑。EST 和 BMT 在降低 SISMAD 患者的长期死亡率、复发症状、严重 SMA 狭窄或闭塞以及再次干预需求方面相似。
