Covered Versus Bare Metal Stents for Chronic Mesenteric Ischemia: Systematic Review and Meta-analysis

Abstract

Endovascular revascularization through mesenteric stenting is the preferred initial treatment strategy for symptomatic chronic mesenteric ischemia (CMI), but restenosis and symptom recurrence are common. Emerging evidence suggests that covered stents (CS) may reduce or delay the incidence of in-stent restenosis compared with traditional bare metal stents (BMS). Our study objective was to compare the performance of CS to BMS in the management of CMI. We searched PubMed and Embase databases (inception to April 27, 2021) for studies comparing CS with BMS in the management of CMI following the PRISMA guidelines. The abstract and full-text screening were done in parallel by two authors, resolving conflicts by reviewing them with a third author. Our outcomes of interest were loss of primary patency, restenosis, and symptom recurrence at the latest follow-up. Primary analysis was performed using random-effects models and heterogeneity was measured using the I2 statistic. We assessed the quality of observational studies using the Newcastle-Ottawa Scale. The predefined protocol was registered in PROSPERO. We double-screened a total of 502 articles, of which four observational studies (n = 432 patients, 511 vessels) were included (Fig 1). CS were used in 20.4% of vessels (n = 104). When compared with BMS, the use of CS was associated with lower odds of loss of primary patency (pooled odds ratio, 0.37; 95% confidence interval [CI], 0.15-0.90; P value = 0.029; I2 = 58.9%; n = 511 vessels) (Fig 2). CS were also associated with lower odds of restenosis (pooled odds ratio, 0.12; 95% CI, 0.06-0.23; P < 0.001; I2 = 0%; n = 280 patients). One study reported lower symptom recurrence associated with CS use (OR, 0.08; 95% CI, 0.02-0.23; P < 0.001; n = 189 patients). The length of follow-up varied across studies (median follow-up range, 16-31 months). Heterogeneity was high, and the overall quality of included studies was low owing to small sample sizes, single-center design, retrospective data collection, differential follow-up between treatment groups, and risk for systematic or selection bias. Available data comparing BMS with CS for use in patients with CMI are limited and of variable quality. Although endovascular treatment with CS was associated with lower odds of loss of primary patency and restenosis when compared with BMS, these results must be interpreted with caution. (PROSPERO CRD42021281294).Fig 2Pooled odds ratio (OR) for loss of patency at latest follow-up. 95%-CI, 95% confidence interval.View Large Image Figure ViewerDownload Hi-res image Download (PPT)