Balloon- versus self-expandable stents in the endovascular treatment of adults with aortic coarctation: A systematic review and meta-analysis

Background

Coarctation of the aorta (CoA) is a congenital cardiovascular defect that may persist into adulthood. Endovascular stenting has become the preferred approach, with balloon-expandable stents (BES) and self-expandable stents (SES) being commonly used. However, there is a notable paucity of comparative data evaluating their relative safety and efficacy.

Objectives

We aimed to compare the outcomes of BES and SES in the endovascular management of adults with CoA.

Methods

A systematic review and meta-analysis were performed by searching MEDLINE, Scopus, and the Cochrane Library for studies directly comparing BES and SES in adult CoA patients. Eligible studies included randomized controlled trials and observational studies. Pooled odds ratios (OR) with 95 % confidence intervals (CI) were calculated using a random-effects model.

Results

Three studies (one RCT, two observational), comprising 282 patients, were included, of whom 53.5 % received BES. No significant differences were observed in the cumulative peri-procedural complications [OR 2.5; 95 % CI 0.4 to 18.2; p = 0.07, I² = 9 %], stent migration [OR 1.1; 95 % CI 0.3 to 4.0; p = 0.94; I² = 51 %], and persistent hypertension post-intervention [OR 0.8; 95 % CI 0.4 to 1.6; p = 0.60; I² = 0 %]. Heterogeneity was minimal across most outcomes.

Conclusion

Our analysis suggests that BES and SES offer comparable safety and efficacy in the endovascular treatment of adult CoA. However, the small number of studies and wide confidence intervals warrant cautious interpretation. These findings highlight the need for larger, prospective randomized trials to better guide stent selection in this population.