腸骨分岐デバイスにおけるブリッジングステントとしてのAdvanta V12/iCastの転帰に関する系統的レビューおよびメタアナリシス
George Apostolidis1, Konstantinos Dakis2, José I Torrealba1
1German Aortic Centre, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, Hamburg, Germany.
Purpose:
Iliac branch devices (IBDs) are indicated for the preservation of internal iliac artery (IIA) perfusion. Data on bridging stent choice in IBD are limited. The aim of this meta-analysis was to assess Advanta V12/iCast outcomes when used as bridging stent during IBD procedures.
Methods:
The English medical literature was systematically searched through PubMed, Scopus, and Cochrane Library (last search: 03.01.2025). The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed, and a predefined protocol was registered to PROSPERO. Randomized controlled trials and observational studies (2000--2025) reporting on the Advanta V12/iCast-related outcomes were eligible. The ROBINS-I tool and Grading of Recommendations Assessment, Development and Evaluations (GRADE) were used to assess the risk of bias and quality of evidence. Primary outcomes were technical success, stenosis/occlusion, endoleak Ic/IIIc, and reintervention rates during follow-up. Data on the outcomes of interest were synthesized using proportional meta-analysis.
Results:
From 2698 study reports, 10 observational studies (510 targeted IIAs, 467 IIAs bridged with Advanta V12/iCast) were included. According to ROBINS-I, eight studies were of low and two were of moderate quality. Technical success was 98% (95% confidence interval (CI) = 93%-100%; I2 = 0%; certainty: very low). Regarding the 30-day outcomes, the occlusion/stenosis rate was 2% (95% CI = 0%-9%; I2 = 0%), the endoleak Ic/IIIc rate was 0.3% (95% CI = 0%-3%; I2 = 0%) and the reintervention rate was 1% (95% CI = 0%-3%; I2 = 0%). The mean follow-up among studies was 23.4 months (95% CI = 14.2-32.7). During follow-up, the occlusion/stenosis rate was 4% (95% CI = 1%-11%; I2 = 19%; certainty: very low), the endoleak Ic/IIIc overall rate was 5% (95% CI = 3%-8%; I2 = 0%; certainty: very low), and the reintervention rate was 5% (95% CI = 3%-9%; I2 = 0%; certainty: very low).
Conclusions:
The Advanta V12/iCast balloon-expandable covered stent showed low occlusion/stenosis, endoleak, and reintervention rates at 30 days and follow-up and appeared to be a reliable bridging stent choice in IBDs.Clinical ImpactThe available literature on iliac branch devices does not provide adequate evidence supporting bridging stent selection. This systematic review and meta-analysis on the use of Advanta V12/iCast as bridging stent showed a high technical success rate of 98%, along with low occlusion/stenosis, endoleak Ic/IIIc and reintervention rates at 30 days, which were maintained below 5% during the total follow-up. These results reflect on the reliability of Advanta V12/iCast when used as bridging stent in iliac branch devices. However, the low quality of evidence should be considered upon result interpretation.
