Balloon Dilatation and Stenting for Aortic Coarctation: A Systematic Review and Meta-Analysis

Circ Cardiovasc Interv. 2016 Jun;9(6):e003153. doi: 10.1161/CIRCINTERVENTIONS.115.003153.


Background: There is no systematic assessment of available evidence on effectiveness and comparative effectiveness of balloon dilatation and stenting for aortic coarctation.

Methods and results: We systematically searched 4 online databases to identify and select relevant studies of balloon dilatation and stenting for aortic coarctation based on a priori criteria (PROSPERO 2014:CRD42014014418). We quantitatively synthesized results for each intervention from single-arm studies and obtained pooled estimates for relative effectiveness from pairwise and network meta-analysis of comparative studies. Our primary analysis included 15 stenting (423 participants) and 12 balloon dilatation studies (361 participants), including patients ≥10 years of age. Post-treatment blood pressure gradient reduction to ≤20 and ≤10 mm Hg was achieved in 89.5% (95% confidence interval, 83.7-95.3) and 66.5% (44.1-88.9%) of patients undergoing balloon dilatation, and in 99.5% (97.5-100.0%) and 93.8% (88.5-99.1%) of patients undergoing stenting, respectively. Odds of achieving ≤20 mm Hg were lower with balloon dilatation as compared with stenting (odds ratio, 0.105 [0.010-0.886]). Thirty-day survival rates were comparable. Numerically more patients undergoing balloon dilatation experienced severe complications during admission (6.4% [2.6-10.2%]) compared with stenting (2.6% [0.5-4.7%]). This was supported by meta-analysis of head-to-head studies (odds ratio, 9.617 [2.654-34.845]) and network meta-analysis (odds ratio, 16.23, 95% credible interval: 4.27-62.77) in a secondary analysis in patients ≥1 month of age, including 57 stenting (3397 participants) and 62 balloon dilatation studies (4331 participants).

Conclusions: Despite the limitations of the evidence base consisting predominantly of single-arm studies, our review indicates that stenting achieves superior immediate relief of a relevant pressure gradient compared with balloon dilatation.

Keywords: aneurysm; angioplasty, balloon; congenital; meta-analysis; stent.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Angioplasty, Balloon / adverse effects
  • Angioplasty, Balloon / instrumentation*
  • Angioplasty, Balloon / mortality
  • Aorta / abnormalities
  • Aorta / drug effects
  • Aorta / physiopathology*
  • Aortic Coarctation / diagnostic imaging
  • Aortic Coarctation / mortality
  • Aortic Coarctation / physiopathology
  • Aortic Coarctation / therapy*
  • Arterial Pressure*
  • Humans
  • Network Meta-Analysis
  • Odds Ratio
  • Risk Factors
  • Stents*
  • Treatment Outcome