Comparison of Covered Stent vs Bare Metal Stent Implantation in Aortoiliac Occlusive Disease: A Systematic Review and Meta-Analysis

Abstract

PurposeThis systematic review aimed to compare covered stent (CS) and bare metal stent (BMS) in treating aortoiliac occlusive disease (AIOD). MethodsComprehensive searches were conducted in the Medline, Embase, and Cochrane Library databases for all pertinent studies. The end points included primary patency, secondary patency, freedom from target lesion revascularization (TLR), technical success, ankle-brachial index (ABI) improvement, perioperative complications, major amputation and mortality. Odds ratios (OR) or risk differences (RD) with 95% confidence intervals (CI) were used to estimate the binary variables. The continuous variables were presented as mean difference (MD) with 95% CI. ResultsTen studies involving 1861 limbs were included. For overall outcomes, compared to BMS, CS showed significantly superior in freedom from target lesion revascularization (TLR) (OR=3.00, 95% CI: 1.05-8.51, p=0.04) and ankle-brachial index (ABI) (MD=0.03, 95% CI: -0.00-0.06, p=0.04). No significant differences were found in technical success, primary patency (at 12, 24, 36, and 60 months), secondary patency, perioperative adverse events, major amputation rates and early mortality. Subgroup analyses favored CS in ABI improvement (MD=0.06, 95% CI: 0.02-0.11, p=0.01) after propensity score matching (PSM), and covered balloon expandable stents (BES) demonstrated certain advantages in freedom from TLR (OR=4.60, 95% CI: 1.79-11.81, p=0.002). Additionally, no significant difference in primary patency at 36 months between the two groups with TASC D or severe calcification lesions. ConclusionsCompared to BMS, CS presented advantages in reducing TLR and enhancing ABI improvement. Meanwhile, CS demonstrated comparable technical success, primary patency, secondary patency, perioperative complications, major amputation rates and early mortality.