Covered Versus Bare-Metal Stents in Chronic Mesenteric Ischemia Treatment: A Systematic Review and Meta-Analysis

The main treatment for chronic mesenteric ischemia (CMI) is revascularization, typically achieved through stent angioplasty of the superior mesenteric artery, and in certain cases, the celiac trunk. However, long-term outcomes using bare-metal stents (BMSs) have been less than satisfactory. Therefore, we aimed to compare the performance of covered stents (CSs) versus BMSs in patients treated for CMI.

Pubmed, Embase, and Cochrane Central Register of Controlled Trials databases were systematically searched for studies of patients with CMI who underwent stenting procedures using BMS or CS. The main outcomes were primary patency and freedom from reintervention. Statistical analysis was performed using R version 3.6.

One randomized clinical trial and 5 observational studies were included. In the pooled analysis, patients undergoing the covered stenting approach had a higher primary patency (hazard ratio 0.40; 95% confidence interval 0.23-0.68; P < 0.01). Additionally, CS also demonstrated significantly superior freedom from reintervention when compared to BMS patients (hazard ratio 0.30; 95% confidence interval 0.13-0.71; P < 0.01).

In patients undergoing transluminal angioplasty with stent placement both in the celiac trunk and superior mesenteric artery, the use of CS indicated superior primary patency and a higher rate of freedom from reintervention than BMS. These findings indicate superior outcomes with CS and may suggest their use as the preferred stent option in patients with CMI. However, these findings should be interpreted cautiously due to the limited number of studies, the moderate to serious risk of bias in the included data, and the significant heterogeneity observed. Further high-quality clinical trials are necessary to validate these results and strengthen the evidence base for clinical practice.