EARLY STROKE AFTER AORTIC ARCH REPAIR: COMPARATIVE AND PROPORTIONAL META-ANALYSES OF OPEN, HYBRID, AND TOTAL ENDOVASCULAR STRATEGIES.

IF 3.9 2区医学 Q1 PERIPHERAL VASCULAR DISEASE

Journal of Vascular Surgery Pub Date : 2026-10-16 DOI:10.1016/j.jvs.2026.09.048

M Lourdes Del Río Solá, Marina Jiménez Caja, Clara de la Torre Casaseca, Eva Álvarez García, Carlos García Padrón, Sandra Pérez Fernández

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引用次数: 0

Abstract

Objective: Early stroke remains one of the most devastating complications after aortic arch repair. This systematic review and meta-analysis evaluated early stroke after open, hybrid, and total endovascular aortic arch repair using separate comparative and proportional frameworks.

Methods: PubMed, Scopus, and Web of Science were searched from inception through July 27, 2026. Observational studies reporting neurological outcomes after adult open, hybrid, or total endovascular aortic arch repair were included. The primary comparative meta-analysis pooled propensity score-matched or weighted studies comparing hybrid with open repair using random-effects restricted maximum likelihood models with Hartung-Knapp adjustment. Separate proportional random-effects meta-analyses estimated pooled stroke incidences for each strategy. Risk of bias was assessed using ROBINS-I and the Joanna. Briggs Institute Critical Appraisal Checklist. The protocol was prospectively registered in PROSPERO (CRD420261461659).

Results: Thirty-four studies were included. Seven propensity score-matched or weighted cohorts comprising 948 patients (474 open and 474 hybrid repairs) contributed to the primary comparative meta-analysis. No significant difference in early stroke was identified between hybrid and open repair (OR 1.99, 95% CI 0.46-8.58; P=.292; I²=52.9%). Post hoc comparative analyses restricted to dissection cohorts (3 cohorts; 572 patients) and Zone 0 hybrid repair (3 cohorts; 448 patients) were also inconclusive and highly imprecise. In descriptive proportional analyses, pooled early-stroke incidences were 5.3% after open, 7.5% after hybrid, and 6.4% after total endovascular repair. Technique-stratified incidences were 6.1% for conventional open repair, 4.4% for open repair with frozen elephant trunk, and 5.3% for branched total endovascular repair.

Conclusion: Adjusted comparative evidence showed no significant difference in early stroke between hybrid and open aortic arch repair. Evidence for total endovascular repair remains predominantly non-comparative. Treatment should be individualised according to aortic pathology, urgency, anatomy, operative risk, and institutional expertise.

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主动脉弓修复后早期中风：开放、混合和全血管内策略的比较和比例荟萃分析。

目的：早期中风仍然是主动脉弓修复后最具破坏性的并发症之一。本系统综述和荟萃分析采用单独的比较和比例框架评估开放、混合和全血管内主动脉弓修复后的早期卒中。方法：检索PubMed、Scopus和Web of Science，检索时间为2026年7月27日。观察性研究报告了成人开放式、混合式或全血管内主动脉弓修复后的神经系统预后。主要的比较meta分析汇总了倾向评分匹配或加权研究，使用随机效应限制最大似然模型和Hartung-Knapp调整比较混合和开放式修复。单独的比例随机效应荟萃分析估计了每种策略的卒中发生率。使用ROBINS-I和Joanna评估偏倚风险。布里格斯研究所关键评估清单。该方案在PROSPERO （CRD420261461659）中前瞻性注册。结果：纳入34项研究。7个倾向评分匹配或加权队列包括948例患者（474例开放式修复和474例混合式修复），用于主要的比较荟萃分析。混合修复和开放式修复在早期卒中方面无显著差异（OR 1.99, 95% CI 0.46-8.58； P= 0.292; I2=52.9%）。事后比较分析仅限于解剖队列（3个队列，572例患者）和0区混合修复（3个队列，448例患者）也不确定且高度不精确。在描述性比例分析中，开放式手术后早期卒中发生率为5.3%，混合式手术后为7.5%，全血管内修复后为6.4%。技术分层发生率为：常规开放式修复6.1%，冷冻象鼻开放式修复4.4%，分支全血管内修复5.3%。结论：经校正的比较证据显示，混合主动脉弓修复术与开放式主动脉弓修复术在早期卒中发生率上无显著差异。完全血管内修复的证据主要是非比较性的。治疗应根据主动脉病理、急症、解剖、手术风险和机构专业知识进行个体化治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Vascular Surgery 医学-外科

CiteScore

7.70

自引率

18.60%

发文量

1469

审稿时长

54 days

期刊介绍： Journal of Vascular Surgery ® aims to be the premier international journal of medical, endovascular and surgical care of vascular diseases. It is dedicated to the science and art of vascular surgery and aims to improve the management of patients with vascular diseases by publishing relevant papers that report important medical advances, test new hypotheses, and address current controversies. To acheive this goal, the Journal will publish original clinical and laboratory studies, and reports and papers that comment on the social, economic, ethical, legal, and political factors, which relate to these aims. As the official publication of The Society for Vascular Surgery, the Journal will publish, after peer review, selected papers presented at the annual meeting of this organization and affiliated vascular societies, as well as original articles from members and non-members.