The Fate of False Lumen in Type B and Residual Type A Aortic Dissection Using the Candy-Plug Technique: A Systematic Review and Meta-Analysis

Abstract

Objective:

We performed a systematic review and meta-analysis to evaluate the technical and clinical success of false lumen occlusion with the Candy-plug (CP) technique in patients with type B and residual type A aortic dissection.

Materials and Methods:

A systematic search of all the literature reported until November 2024 was performed according to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. The pooled technical and clinical success and corresponding 95% confidence intervals (CIs) were estimated using fixed or random effect methods.

Results:

A total of 106 study titles were identified by the initial search strategy, of which 6 were considered eligible for inclusion in the meta-analysis. A total of 128 patients (83% male) were identified among the eligible studies. The pooled technical and clinical success rate among the studies were 96% (95% CI, 88–98) and 76% (95% CI, 58–88) respectively. The technical success for custom-made manufacturing device (CMD) was 98.5% (95% CI, 92–99; I²=0%; p=0.78, 2 studies) while for the physician modified CP technique (pmCP) technique was 92.7% (95% CI, 77–98; I²=0%; p=0.79, 4 studies). Overall, false lumen thrombosis rate was 71% (95% CI, 55–83): 80% (95% CI, 57–92; I²=0%; p=0.90, 2 studies) for CMD while for the pmCP technique was 63% (95% CI, 27–88; I²=0%; p=0.99, 4 studies). The pooled aortic remodeling rate was 50% (95% CI, 33–66): 63.2% (95% CI, 52.7–72.5; I²=69%; p=0.68, 2 studies) for CMD, while for the pmCP technique was 35.9% (95% CI, 17–54%; I²=39%; p=0.17, 4 studies). The incidence of CP related reinterventions were 7.1% [11.5% for CMD (95% CI, 0.3–8.4; I²=0%; p=0.09, 2 studies) and 5.1% for pmCP (95% CI, 1.3–18; I²=0%; p=0.96, 4 studies)] and 12.8% [4.5% for CMD (95% CI, 0.3–39; I²=69%; p=0.68, 2 studies), while for the pmCP technique was 4.6% (95% CI, 0.9–19; I²=0%; p=0.90, 4 studies)] in the early and late period.

Conclusion:

CP technique appears to be a promising solution demonstrating high technical success, false lumen thrombosis, and aortic remodeling rate. However, the clinical success rate tends to be lower. Life-long and strict follow-up of these patients may be necessary to monitor CP-related complications, given the limited data on the long-term durability of these devices.

Clinical Impact

This study provides detailed information on a physician-modified candy plug technique in patients with patent False lumen in Type B or residual Type A aortic dissection. As the custom-made candy plug devices have been developed, the delivery time for them varies between countries and vascular surgery services, making the planning of the procedure difficult, especially in symptomatic patients or those with rapid FL diameter progression. The aim of the present study was to collect all available evidence on the fate of the false lumen of the use of custom-made and pmCP technique in TBAD and residual type A aortic dissection.Overall the results suggest that physician modified candy-plug technique is a feasible and promising alternative technique, with high primary technical and clinical success rate.