• Faheem Sheriff, Mehmet Enes Inam, Van Thi Thanh Truong, Victor Lopez-Rivera, Elvira Lekka, Kumail Kermali, Sunil Sheth, Alberto Maud, Vikas Gupta, Gustavo Rodriguez, Claudia Pedroza, and Peng Roc Chen.
• Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, Texas, USA; Department of Neurology, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
• World Neurosurg. 2021 Jul 1; 151: e86-e93.

BackgroundVenous 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.MethodsAn 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.ResultsA 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.ConclusionsWe 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.Copyright © 2021 Elsevier Inc. All rights reserved.

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