Key result
TEVAR yields similar in-hospital mortality to medical management but reduces IMH progression.
Why the study?
Does TEVAR improve clinical and anatomical outcomes compared to medical management in patients with type B intramural hematoma?
Meta-Analysis (n=1,528)
Does TEVAR improve clinical and anatomical outcomes compared to medical management in patients with type B intramural hematoma?
In patients with type B intramural hematoma, TEVAR does not significantly reduce mortality compared to medical management but improves anatomical outcomes such as IMH regression and reduces progression and secondary interventions.
Background The benefit-risk profile of thoracic endovascular aortic repair (TEVAR) in patients with type B aortic intramural hematoma (IMH) has not been well established yet. This study aimed to evaluate the outcomes of TEVAR compared with medical management (MM) in this population. Methods PubMed, EMBASE, the Cochrane Library, and clinicaltrials.gov were searched to identify studies comparing TEVAR with MM in patients with type B IMH. Results Sixteen studies involving 1528 patients were included in this meta-analysis. Compared with the MM group, the TEVAR group displayed similar incidences of in-hospital death [RR (95%CI): 0.73 (0.32-1.66), p=0.45] and aortic-related death [RR (95%CI): 0.70 (0.31-1.58]), p=0.39]. The risk of all-cause death was comparable between the two groups [RR (95%CI): 0.62 (0.36-1.07), p=0.08]. Meanwhile, TEVAR was superior to MM in promoting IMH regression [RR (95%CI): 1.51(1.26-1.81), p<0.001] and reducing IMH progression [RR (95%CI): 0.15 (0.08-0.29), p<0.001], dissection [RR (95%CI): 0.26 (0.12-0.60), p=0.002], and secondary intervention [RR (95%CI): 0.22 (0.08-0.60), p=0.003]. Conclusion In patients with type B IMH, the incidences of in-hospital death, aortic-related death and all-cause death during follow-up were comparable between the TEVAR group and the MM group. However, TEVAR was superior to MM in promoting IMH regression and reducing IMH progression, dissection, and secondary intervention. Further randomized controlled trials are needed to clarify the role of TEVAR in this population.Primary endpoints in TEVAR vs. MM Secondary endpoints in TEVAR vs. MM
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Lyu et al. (2025) conducted a meta-analysis in Type B aortic intramural hematoma (n=1,528). Thoracic endovascular aortic repair (TEVAR) vs. Medical management (MM) was evaluated on In-hospital death (RR 0.73, 95% CI 0.32-1.66, p=0.45). Thoracic endovascular aortic repair showed similar rates of in-hospital death compared to medical management (RR 0.73; 95% CI 0.32-1.66; p=0.45) but significantly reduced IMH progression.
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