Systematic review of STABILISE technique for treatment of type B aortic dissection

Abstract

Objective

The Stent-Assisted Balloon-Induced Intimal Disruption and Relamination in Aortic Dissection Repair (STABILISE) technique was proposed for treating type B aortic dissections (TBADs), using bare metal stents and balloon inflation to intentionally rupture the lamella and allow full expansion of the true lumen (TL) and finally promote aortic remodeling. A systematic review was conducted to assess the current evidence and treatment indications and compare outcomes of the STABILISE technique.

Methods

A literature search in PUBMED and Cochrane Library was performed, and articles that were published up to June 2024 reporting on the STABILISE technique were included (randomized controlled trials, prospective and retrospective studies). Case series with less than four patients were excluded. Titles, abstracts, and full texts were evaluated by two authors independently. Primary outcomes included technical success and 30-day mortality. Secondary outcomes were mortality and complications during the available follow-up. Continuous variables were presented as means ± standard deviation or median and interquartile range, and categorical variables were expressed as numbers (percentages).

Results

Twenty-nine studies were evaluated: 10 studies, totaling 284 patients, were included. Of these patients, 92 of 284 (32%) were acute, 61 of 284 (21.4%) were subacute, and 65 of 284 (22.8%) were chronic TBADs. In 66 of 284 cases (23.2%), the setting of TBAD was not available. Two hundred thirty-six patients were male (236/284; 83.1%). In 85 patients (85/284; 29.9%), supra-aortic trunk debranching was required to provide an appropriate proximal landing zone. Carotid to carotid bypass debranching was performed in all Ishimaru’s zone 1 cases, whereas left carotid-subclavian bypass was performed in 42 of 64 cases (42/65; 65.6%) who underwent aortic zone 2 coverage. One patient died intraoperatively, with an estimated mortality rate of 0.3% (1/284). In 10 studies, nine deaths overall were recorded (9/284; 3.1%). The type of balloon used, the number of inflations, and any additional maneuvers that were carried out during the procedure were never mentioned in the literature. The reintervention rate was 16.9% (48/284 patients). Spinal cord ischemia rate was available in eight studies, resulting in eight patients (8/261; 3.1%). All studies reported on the available follow-up for a median of 29 months. Technical success was reported in all studies, accounting for 280 patients (280/284; 98.6%), for an overall follow-up in 247 patients (247/284; 86.9%).

Conclusions

The STABILISE technique is safe and effective in promoting aortic remodeling over time. Additional research is required to investigate the technique’s safety in a larger patient population and to assess the long-term behavior of the post-dissected aorta.