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Dual Antiplatelet Therapy Duration After Venous Sinus Stenting for Idiopathic Intracranial Hypertension and Stent Survival-Is Longer Necessarily Better? A Meta-Regression
- Source :
- World neurosurgery. 151
- Publication Year :
- 2021
-
Abstract
- Background Venous stenting (VS) for venous sinus stenosis in the setting of idiopathic intracranial hypertension has been increasing in acceptance by neurointerventionalists. Stent-adjacent stenosis (SAS) and in-stent stenosis leading to symptom recurrence and the need for retreatment are known delayed complications. However, the effect of the dual antiplatelet therapy (DAPT) duration on these complications has remained poorly characterized. Methods An extensive literature search was performed to identify reports of VS for patients with idiopathic intracranial hypertension from 2000 to 2020. The primary outcome was the occurrence of SAS. The secondary outcomes included the occurrence of composite stenosis (in-stent stenosis and SAS) and stent survival, defined as the need for retreatment or other surgical management. Generalized linear mixed models were used to explore the effects of DAPT duration (3 vs ≥6 months) on the primary and secondary outcomes. Results A total of 325 patients met the inclusion criteria and were included in our analysis. SAS occurred in 9% (95% confidence interval, 6%-15%) of the patients, and stent survival was 90% (95% confidence interval, 84%-93%) in the cohort. With every 1-mm Hg increase in the venous pressure gradient, an 8% decrease was found in the odds of stent survival (P = 0.043). The meta-regression revealed no association between the DAPT duration and the primary outcome or the odds of composite stenosis and stent survival. Conclusions We found no differences between 3 and ≥6 months of DAPT in terms of the risk of stent stenosis or stent survival. However, patients with a higher venous pressure gradient before VS had a greater risk of stent failure.
- Subjects :
- Adult
Male
medicine.medical_specialty
Central Venous Pressure
medicine.medical_treatment
Spinal Puncture
Neurosurgical Procedures
03 medical and health sciences
Sinus Thrombosis, Intracranial
0302 clinical medicine
Recurrence
Internal medicine
Medicine
Therapy duration
Humans
Meta-regression
cardiovascular diseases
Treatment Failure
Sinus (anatomy)
Retrospective Studies
Pseudotumor Cerebri
Aspirin
business.industry
Venous pressure
Graft Occlusion, Vascular
Stent
equipment and supplies
medicine.disease
Confidence interval
Clopidogrel
Stenosis
medicine.anatomical_structure
Treatment Outcome
030220 oncology & carcinogenesis
Cohort
Cardiology
Linear Models
Regression Analysis
Surgery
Drug Therapy, Combination
Female
Stents
Neurology (clinical)
business
030217 neurology & neurosurgery
Platelet Aggregation Inhibitors
Subjects
Details
- ISSN :
- 18788769
- Volume :
- 151
- Database :
- OpenAIRE
- Journal :
- World neurosurgery
- Accession number :
- edsair.doi.dedup.....18f12883ac76cd9e880b0f6a39f85077