A systematic review and meta-analysis of the performance of flow-diverting stents in the treatment of peripheral and visceral artery aneurysms.

Abstract

This meta-analysis aims to evaluate the safety and efficacy of flow-diverting stents (FDS) in treating peripheral and visceral artery aneurysms (PAA/VAAs). Though rare, PAA/VAAs can represent a life-threatening condition due to their propensity of rupture. The FDS emerges as a new solution to exclude these aneurysms while maintaining collateral branches, but convincing evidence is lacking on its clinical effectiveness. A systematic literature search was performed to identify studies related to FDS in treating PAA/VAAs. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement was applied to guide the data extraction, quality assessment, and synthesis of outcomes of interest. Random effect models were applied to calculate the event rates of major endpoints. OpenMeta[Analyst] software was used for statistical analysis. Of 130 records screened, 10 cohort studies (including 220 patients, average age: 66.0 years, 78.4% male) were enrolled in the meta-analysis. Pooled data suggested a technical success rate of 98.5% (95% CI: 97.0-100%). During a mean follow-up period of 14.1 months, 93.6% (95% CI: 88.6-98.5%) side branches remained patent, 89.8% (95% CI: 84.3-95.3%) aneurysms were totally thrombosed, whereas shrinkage/stabilization of the aneurysm was documented in 93.4% (95% CI: 88.4-98.4%) cases. The primary stent patency rate was estimated to be 87.9% (95% CI: 81.0-94.8%). Overall clinical success was achieved in 83.2% (95% CI: 74.4-92.0%) patients. The FDS features a potential advantage of preserving side branches while inducing sac thrombosis and aneurysm shrinkage/stabilization. Further prospective, comparative studies in larger patient cohorts are anticipated to draw a robust conclusion.