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

Purpose

This systematic review aimed to compare covered stent (CS) and bare-metal stent (BMS) implantation in treating aortoiliac occlusive disease.

Materials and Methods

Comprehensive 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, periprocedural adverse events, major amputation, and mortality. Odds ratios (OR) or risk differences with 95% CIs were used to estimate the binary variables. The continuous variables were presented as mean difference (MD) with 95% CI.

Results

Ten studies involving 1,861 limbs were included. For overall outcomes, compared with BMS, CS showed significantly superior in freedom from TLR (OR, 3.00; 95% CI, 1.05–8.51; P = .04) and ABI (MD, 0.03; 95% CI, −0.00 to 0.06; P = .04). No significant differences were found in technical success, primary patency (at 12, 24, 36, and 60 months), secondary patency, periprocedural 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 = .01) after propensity score matching, and covered balloon-expandable stents demonstrated certain advantages in freedom from TLR (OR, 4.60; 95% CI, 1.79–11.81; P = .002). Additionally, no significant difference in primary patency at 36 months between the 2 groups with Trans-Atlantic Inter-Society Consensus D or severe calcification lesions.

Conclusions

Compared with BMS, CS presented advantages in reducing TLR and enhancing ABI improvement. Meanwhile, CS demonstrated comparable technical success, primary patency, secondary patency, periprocedural adverse events, major amputation rates, and early mortality.