European Heart Journal Advance Access originally published online on October 14, 2005
European Heart Journal 2006 27(4):489-498; doi:10.1093/eurheartj/ehi493
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Endovascular stent–graft placement in aortic dissection: a meta-analysis
1Department of Cardiology, West-German Heart Center Essen, University of Duisburg-Essen, Hufelandstraße 55, 45122 Essen, Germany
2Department of Cardiology, University of Rostock, Rostock, Germany
3Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
4Department of Cardio-thoracic Surgery, West-German Heart Center Essen, University of Duisburg-Essen, Essen, Germany
Received 23 June 2005; revised 11 August 2005; accepted 19 August 2005; online publish-ahead-of-print 14 October 2005.
* Corresponding author. Tel: +49 201 723 4888; fax: +49 201 723 5480. E-mail address: holger.eggebrecht{at}uni-essen.de
See page 384 for the editorial comment on this article (doi:10.1093/eurheartj/ehi665)
Aims This article summarizes all available published data with respect to clinical success, complications, and outcomes of endovascular stent–graft placement among patients with descending aortic dissection (AD).
Methods and results We performed a meta-analysis of all published series on retrograde endovascular stent–graft placement encompassing 
3 patients with AD. Thirty-nine studies, involving a total of 609 patients, were included. Procedural success was reported in 98.2±0.5% of patients. Major complications were reported in 11.1±1.4%, with the most dreaded neurologic complications in 2.9±0.7% patients. Periprocedural stroke was encountered more frequently than paraplegia (1.9±0.6% vs. 0.8±0.4%). Overall complications were significantly higher in patients undergoing stent–graft placement for acute AD than in patients with chronic AD (21.7±2.8% vs. 9.1±2.3%, P=0.005). The overall 30-day mortality was 5.3±0.9%, and was three-fold higher in patients with acute AD when compared with chronic AD (9.8±2.2% vs. 3.2±1.4%, P=0.015). In addition, 2.8±0.7% of patients died over a mean follow-up period of 19.5±7.1 months. Kaplan–Meier analysis yielded overall survival rates of 90.6±1.6% at 6 months, 89.9±1.7% at 1 year, and 88.8±1.9% at 2 years, respectively.
Conclusion Endovascular stent–graft placement in type B-AD is technically feasible with success rates of >95% in selected cohort. Although minimally invasive, major complications occurred in 14–18% of patients depending upon the acuity of presentation, with very low incidence of paraplegia. Both, acute and mid-term mortality of this novel treatment strategy appear to favourably compare with surgical treatment but further studies are necessary to compare stent–graft placement with medical treatment in uncomplicated AD.
Key Words: Aorta • Dissection • Stent • Endovascular • Prognosis
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