Midterm Results of the Conservative, Bare Stent, and Bare Stent-Assisted Coiling Treatments for Symptomatic Isolated Superior Mesenteric Artery Dissection

Abstract

We compared the early and mid-term (31, 3-63 months) outcomes of conservative treatment, bare stent treatment (BST) and bare stent-assisted coiling treatment (BSACT) to determine the most effective treatment for patients with symptomatic isolated superior mesenteric artery dissection (SISMAD). Consecutive patients with SISMAD admitted to the study hospital between January 2016 and December 2021 were included in this retrospective study. Their demographic data, clinical findings, treatment options, early outcomes and follow-up results were analyzed. A total of 121 patients were included in the study (23 with conservative treatment, 42 with BST, 56 with BSACT). Symptoms were relieved in 91.3% of conservative patients, whereas all patients (100%) with BST or BSACT had symptom relief, p= .035. There was no significant difference in the length of hospital stay between the two endovascular treatments (EVT) (p=0.9051), but hospital stay was significantly shorter compared to conservative treatment (p<0.0001). The cumulative rate of complete remodeling was 100% for BSACT vs. 46.3% for BST (p < .0001) vs. 42.9% for conservative patients (p < .0001). There were no significant differences between the last two groups (p = .3925). The prevalence of adverse events for abdominal pain recurrence and aneurysm formation was also significantly lower in the BSACT group at follow-up. BSACT for SISMAD has a preferable early outcome. The cumulative complete remodeling rate and the event-free survival rate are satisfactory at mid-term follow-up. BSACT is an effective approach for SISMAD.