使用覆膜球囊扩张支架对主动脉缩窄进行血管内治疗——一项系统评价和荟萃分析
Endovascular treatment of aortic coarctation using covered balloon-expandable stents-a systematic review and meta-analysis.
作者信息
He Fei, Cao Zhongze, Wang Chen, Premaratne Shyamal, Starnes Benjamin W, Shu Chang, Zhang Wayne W
机构信息
Department of Vascular Surgery, Huaihe Hospital, Henan University, Kaifong, Henan, China.
Center of Vascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
出版信息
Front Cardiovasc Med. 2024 Oct 17;11:1439458. doi: 10.3389/fcvm.2024.1439458. eCollection 2024.
OBJECTIVES
Balloon dilation followed by balloon-expandable stent implantation is an effective treatment for improving hemodynamic status in patients with coarctation of the aorta (CoA). However, limited evidence exists regarding the safety and efficacy of covered balloon-expandable stents (CBSs) in a large cohort. In this meta-analysis, we aimed to evaluate the overall success rates, hemodynamic and anatomical benefits, complications, and mid-term results of CBSs in treating CoA.
METHODS
The PubMed, Embase, and Cochrane Library databases were systemically searched for studies reporting outcomes of CBSs in treating CoA. Single-group rate meta-analyses were performed to calculate estimated pooled procedural success rates, the incidence of complications, and re-coarctation rates. A meta-analysis using standardized mean differences was conducted to compare pre- and postoperative trans-coarctation pressure gradients (PGs), coarctation diameter, and overall changes in systolic blood pressure (SBP). Subgroup analyses were performed to identify potential sources of heterogeneity.
RESULTS
The final analysis included 12 studies with a total of 411 patients. The estimated pooled procedural success rate was 100% [95% confidence interval (CI): 98%-100%, 2 = 0, = 0.78]. Significant decreases in trans-coarctation PGs and SBP were observed. The pooled incidences of stent-related, aortic, and access site complications were 2% (95% CI: 0%-5%, = 30.4%, = 0.15), 2% (95% CI: 0%-4%, = 0%, = 0.76), and 3% (95% CI: 1%-7%, = 52.9%, = 0.02), respectively. Subgroup analyses showed that implantation of BeGraft stents was related to a significantly higher incidence of access site complications.
CONCLUSION
Covered balloon-expandable stent implantation in treating CoA is safe and effective with high procedural success rates, an acceptable incidence of complications, and a low incidence of re-coarctation.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/, PROSPERO (CRD42023430356).
目的
球囊扩张后植入球囊可扩张支架是改善主动脉缩窄（CoA）患者血流动力学状态的有效治疗方法。然而，关于覆膜球囊可扩张支架（CBSs）在大型队列中的安全性和有效性的证据有限。在这项荟萃分析中，我们旨在评估CBSs治疗CoA的总体成功率、血流动力学和解剖学益处、并发症及中期结果。
方法
系统检索PubMed、Embase和Cochrane图书馆数据库，查找报告CBSs治疗CoA结果的研究。进行单组率荟萃分析，以计算估计的合并手术成功率、并发症发生率和再缩窄率。使用标准化均数差进行荟萃分析，以比较术前和术后跨缩窄段压力梯度（PGs）、缩窄段直径和收缩压（SBP）的总体变化。进行亚组分析以确定异质性的潜在来源。
结果
最终分析纳入12项研究，共411例患者。估计的合并手术成功率为100%[95%置信区间（CI）：98%-100%，I² = 0，P = 0.78]。观察到跨缩窄段PGs和SBP显著降低。支架相关、主动脉和穿刺部位并发症的合并发生率分别为2%（95%CI：0%-5%，I² = 30.4%，P = 0.15）、2%（95%CI：0%-4%，I² = 0%，P = 0.76）和3%（95%CI：1%-7%，I² = 52.9%，P = 0.02）。亚组分析显示，植入BeGraft支架与穿刺部位并发症的发生率显著较高有关。
结论
覆膜球囊可扩张支架植入治疗CoA安全有效，手术成功率高，并发症发生率可接受，再缩窄发生率低。
系统评价注册
https://www.crd.york.ac.uk/PROSPERO/，PROSPERO（CRD42023430356）。
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