Stent versus Trunk: Who Wins the Aortic Tug-of-War in Type A Dissection? A Systematic Review and Single-Arm Meta-Analysis

The frozen elephant trunk (FET) and Ascyrus Medical Dissection Stent (AMDS) are hybrid techniques used in managing acute type A aortic dissection (ATAAD). This systematic review and meta-analysis compared their perioperative outcomes, aortic remodeling, and incidence of distal anastomotic new entry (DANE).A comprehensive search yielded 611 studies; after screening, 68 were included-59 on FET and 9 on AMDS-covering 7,420 patients (7,070 FET; 350 AMDS). The primary outcome was DANE incidence. Secondary outcomes included operative time, false lumen thrombosis, ICU/hospital stay, and 30-day/in-hospital mortality.DANE incidence was 7% in both groups. FET was associated with shorter operative times (353-369 vs. 422 minutes), higher false lumen thrombosis rates (88-89% vs. 84%), and longer hospital stays (17-19 vs. 9-11 days). AMDS had longer ICU stays (7.7-8.5 vs. 5.3-7.5 days). Mortality rates were similar (FET: 8-9%; AMDS: 7-10%). Critically, neurological complication rates were substantially higher with AMDS (33% [15-53%]) compared with FET (13% [10-16%]). However, the evidence base for AMDS remains limited (9 studies) compared with FET (59 studies). Egger's test showed publication bias in FET studies for DANE and length of stay outcomes; bias assessment for AMDS was limited by study number.Limited available evidence suggests that FET and AMDS show similar DANE and mortality outcomes. FET may favor better remodeling and a safer neurological profile, but longer hospitalization, though high heterogeneity and limited AMDS data underscore the need for robust comparative trials.