STABILISE for acute type B aortic dissection - systematic review

Abstract

Introduction: Stent-assisted, balloon-induced intimal disruption and relamination of aortic dissection (STABILISE) is an extended downstream endovascular management technique for acute type B aortic dissection (TBAD), that aims to achieve complete aortic remodelling. This systematic review aims to assess the early and mid-term clinical outcomes with STABILISE in the management of TBAD. Evidence acquisition: A literature search was performed on the MEDLINE, Web of Science, Scopus and SciELO databases, which returned 195 studies. Five studies were included. Data were extracted using predefined forms. Evidence synthesis: In total, one hundred patients with acute or subacute TBAD managed with STABILISE were included. All studies reported a technical success of 100%. Thirty-day mortality was estimated at 4% (4/100) with no further deaths documented during an estimated mean follow-up of 12.7 months (range 12-15 months). 5% developed spinal cord ischemia and another 5% developed visceral artery occlusions. One case of aortic rupture during time of balloon inflation was reported. Rare complications included delayed retrograde dissection (1%), aortobronchial fistula (1%) and renal failure (1%). One case of disconnection between stent-graft and bare stent was documented. 6% of patients developed endoleak, predominately type I. Overall re-intervention rate was 21%, reported in all studies. Complete obliteration of the false lumen in the thoracic aorta was achieved in 99% of patients and in the abdominal aorta in 96% of patients. Conclusions: The STABILISE technique carries an acceptable operative safety profile with high technical success and low mortality and morbidity. Excellent results on complete false lumen obliteration were observed. However, the heterogeneity among available studies' methodology does not permit firm conclusions, and further prospective analyses are needed to study the long-term outcomes of STABILISE.