Covered versus uncovered stents for malignant superior vena cava syndrome: a systematic review and meta-analysis
DOI:
https://doi.org/10.48750/acv.614Keywords:
Endovascular, Superior Vena Cava Syndrome, Malignant, Systematic reviewAbstract
INTRODUCTION: In recent years, endovascular stenting has emerged as a promising palliative therapeutic modality for carefully selected patients with Superior Vena Cava Syndrome (SVCS) secondary to intra-thoracic malignancies. However, a lack of data hinders procedure standardization, particularly regarding the dichotomy of covered versus uncovered stents. This study aims to compare the outcomes of malignant SVCS treated with covered versus uncovered stents. To the best of our knowledge, no past review has directly attained this dichotomy in malignant SVCS.METHODS: A systematic review and meta-analysis were performed based in the PRISMA guidelines. COCHRANE and PUBMED databases were searched up to February 2024. Only original studies including 10 or more patients were considered. Primary outcomes were defined as technical and clinical success. Secondary outcomes were defined as primary and secondary patency, complications, recurrence of symptoms, reinterventions, and mean survival.
RESULTS: Our search yielded 17 studies, encompassing 1123 participants (109 submitted to covered stents and 1014 to uncovered stents). Technical success was very high in covered and uncovered stents: pooled data 100% (95% confidence interval [CI] not estimable [NE]) versus 97.9% (95% CI 96.5-99.3), respectively. A single study compared clinical success with a trend towards best results in the covered group, but it was not significant: OR 1.59 (95% CI 0.25-10.13). The complication rate was 0% (95% CI NE) versus 6.2% (95% CI 0.6-11.8), and the re-intervention rate was 1.7% (95% CI 0.0-28.2) versus 9.0% (95% CI 2.7-15.4) for covered and uncovered stents, respectively. A single study directly compared primary patency between groups, with no difference at one month: OR 1.03 (95% CI 0.06-17.09). However, the difference became statistically significant at 6 and 12 months, favoring covered stents: OR 8.75 (95% CI 1.79-42.67) and OR 19.56 (95% CI 4.08-93.82), respectively. Pooled primary patency at 12 months was 90.9% (95% CI 45.9-100) and 77.1% (95% CI 46.0-100) for covered and uncovered stents, respectively.
CONCLUSIONS: Our findings suggest that endovascular implant of covered stents represents a promising approach with superior primary patency rates (versus uncovered). However, limited data from heterogeneous studies hinders definite conclusions, and further investigation is necessary.
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