Background: To compare the clinical outcomes of balloon-expandable (BEXP) versus self-expandable (SEXP) covered stents in the endovascular treatment of aortoiliac occlusive disease (AIOD) through a systematic review and meta-analysis. Methods: A comprehensive literature search was conducted across multiple databases to identify studies comparing BEXP and SEXP stents in patients with Trans-Atlantic Inter-Society Consensus (TASC) A-D AIOD. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the research question was structured using the Population/Patient, Intervention, Comparison, and Outcome framework. Endpoints included technical success, perioperative complications, late stent-related complications, limb salvage, and overall mortality. The protocol was registered in PROSPERO (CRD420251005400). Study quality was assessed using a validated checklist, and pooled estimates were calculated using a random-effects model. Results: Twelve studies involving 891 patients (647 BEXP, 244 SEXP) were included. Technical success was 96.9%% (95% confidence interval 94.09-98.49). Kissing stent configuration was employed in 82.1% of cases, and a percutaneous approach was used in 94.5% of interventions. Predilation was used in 47.2%, and additional bare-metal stents were required in 38.9% of patients. Perioperative complications occurred in 3.9% of cases, and perioperative mortality was 0.4%. In the postoperative period, dual antiplatelet therapy was used 68.9%. Mean follow-up was 25.8 months (95% CI: 15.2-36.4). During follow-up, late stent-related complication occurred in 9.1%, major limb amputation in 1.8%, and overall mortality in 8.6%. Although baseline characteristics and technical details varied, the meta-analysis did not reveal statistically significant differences between BEXP and SEXP in any of the key clinical outcomes, except for perioperative complication. All included studies were rated as either 'fair' or 'good' in methodological quality. Conclusion: BEXP and SEXP covered stents show comparable safety and efficacy in the endovascular treatment of AIOD. However, further studies are needed to identify which patient profiles and anatomical characteristics may benefit more from one stent type over the other. The overall methodological quality of the included studies, although variable, supports the reliability of our findings.
Systematic Review and Meta-Analysis of Balloon Expandable Versus Self-Expandable Covered Stent in Aortoiliac Occlusive Disease
Veraldi, Gian Franco
2026-01-01
Abstract
Background: To compare the clinical outcomes of balloon-expandable (BEXP) versus self-expandable (SEXP) covered stents in the endovascular treatment of aortoiliac occlusive disease (AIOD) through a systematic review and meta-analysis. Methods: A comprehensive literature search was conducted across multiple databases to identify studies comparing BEXP and SEXP stents in patients with Trans-Atlantic Inter-Society Consensus (TASC) A-D AIOD. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the research question was structured using the Population/Patient, Intervention, Comparison, and Outcome framework. Endpoints included technical success, perioperative complications, late stent-related complications, limb salvage, and overall mortality. The protocol was registered in PROSPERO (CRD420251005400). Study quality was assessed using a validated checklist, and pooled estimates were calculated using a random-effects model. Results: Twelve studies involving 891 patients (647 BEXP, 244 SEXP) were included. Technical success was 96.9%% (95% confidence interval 94.09-98.49). Kissing stent configuration was employed in 82.1% of cases, and a percutaneous approach was used in 94.5% of interventions. Predilation was used in 47.2%, and additional bare-metal stents were required in 38.9% of patients. Perioperative complications occurred in 3.9% of cases, and perioperative mortality was 0.4%. In the postoperative period, dual antiplatelet therapy was used 68.9%. Mean follow-up was 25.8 months (95% CI: 15.2-36.4). During follow-up, late stent-related complication occurred in 9.1%, major limb amputation in 1.8%, and overall mortality in 8.6%. Although baseline characteristics and technical details varied, the meta-analysis did not reveal statistically significant differences between BEXP and SEXP in any of the key clinical outcomes, except for perioperative complication. All included studies were rated as either 'fair' or 'good' in methodological quality. Conclusion: BEXP and SEXP covered stents show comparable safety and efficacy in the endovascular treatment of AIOD. However, further studies are needed to identify which patient profiles and anatomical characteristics may benefit more from one stent type over the other. The overall methodological quality of the included studies, although variable, supports the reliability of our findings.
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