Safety and Efficacy Comparison Between OACs Plus Single Antiplatelet and Dual Antiplatelet Therapy in Patients with Cerebral Venous Sinus Stenosis Poststenting

Overview

Journal BMC Neurol

Publisher Biomed Central

Specialty Neurology

Date 2022 Jun 6

PMID 35668360

Authors

Chaobo Bai

Zhiying Chen

Xiaoqin Wu

Roxanne Ilagan

Yuchuan Ding

Xunming Ji

Ran Meng

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: The present strategies regarding poststent management for cerebral venous sinus stenosis (CVSS) are inconsistent. Herein, we compared the safety and efficacy of oral anticoagulants (OACs) plus single antiplatelet therapy and dual antiplatelet therapy for CVSS poststenting.

Methods: A real-world observational study conducted from January 2009 through October 2019 enrolled patients who were diagnosed with CVSS and received stenting. Patients were divided into two groups according to the management they received poststenting. Group 1: OACs plus a single antiplatelet agent (clopidogrel 75 mg or aspirin 100 mg) and Group 2: dual antiplatelet therapy (clopidogrel 75 mg plus aspirin 100 mg). The safety (such as major or minor bleeding or venous thrombosis) and efficacy (the incidences of cerebral venous sinus restenosis, intrastent thrombosis, or stent displacement) of the two groups were compared.

Results: There were a total of 110 eligible patients in the final analysis, including 79 females and 31 males with a mean age of 43.42 ± 13.23 years. No major bleeding or venous thrombosis occurred in either of the two groups. Two minor bleeding events occurred in group 2 (one with subcutaneous bleeding points in both lower limbs, another with submucosal bleeding in the mouth), whereas no bleeding events occurred in Group 1. In addition, at the 1-year follow-up, one case of intraluminal restenosis and two cases of in-stent thrombi occurred in Group 2, while none occurred in Group 1. Neither stenosis at stent-adjacent segments nor stent migration was detected in either group during the 1-year following stent placement.

Conclusion: OACs plus single antiplatelet therapy and dual antiplatelet therapy alone are both safe and efficacious management strategies after CVSS stent placement. The former may have more advantages than the latter for inhibiting intrastent thrombosis. However, further research by larger, multicenter clinical trials is needed.

Citing Articles

Cerebral Venous Thrombosis in Patients With Traumatic Brain Injury: Epidemiology and Outcome.

Goncalves J, Carvalho V, Cerejo A, Polonia P, Monteiro E Cureus. 2024; 16(3):e55775.

PMID: 38586751 PMC: 10999236. DOI: 10.7759/cureus.55775.

Long-term safety and efficacy of stenting on correcting internal jugular vein and cerebral venous sinus stenosis.

Bai C, Chen Z, Ding Y, Ji X, Yuan J, Meng R Ann Clin Transl Neurol. 2023; 10(8):1305-1313.

PMID: 37272913 PMC: 10424652. DOI: 10.1002/acn3.51822.

References

Levitt M, Albuquerque F, Ducruet A, Kalani M, Mulholland C, McDougall C . Venous sinus stenting for idiopathic intracranial hypertension is not associated with cortical venous occlusion. J Neurointerv Surg. 2015; 8(6):594-5. DOI: 10.1136/neurintsurg-2015-011692. View

Song S, Lan D, Wu X, Ding Y, Ji X, Meng R . Clinical characteristics, inflammation and coagulation status in patients with immunological disease-related chronic cerebrospinal venous insufficiency. Ann Transl Med. 2021; 9(3):236. PMC: 7940939. DOI: 10.21037/atm-20-4201. View

Mollan S, Ali F, Hassan-Smith G, Botfield H, Friedman D, Sinclair A . Evolving evidence in adult idiopathic intracranial hypertension: pathophysiology and management. J Neurol Neurosurg Psychiatry. 2016; 87(9):982-92. PMC: 5013119. DOI: 10.1136/jnnp-2015-311302. View

Bai C, Chen J, Wu X, Ding Y, Ji X, Meng R . Perioperative mannitol intensive use may avoid the early complication of cerebral venous sinus stenting. Ann Transl Med. 2020; 8(11):672. PMC: 7327372. DOI: 10.21037/atm-20-3021. View

Ezekowitz M, Connolly S, Parekh A, Reilly P, Varrone J, Wang S . Rationale and design of RE-LY: randomized evaluation of long-term anticoagulant therapy, warfarin, compared with dabigatran. Am Heart J. 2009; 157(5):805-10, 810.e1-2. DOI: 10.1016/j.ahj.2009.02.005. View

Ducruet A, Crowley R, McDougall C, Albuquerque F . Long-term patency of venous sinus stents for idiopathic intracranial hypertension. J Neurointerv Surg. 2013; 6(3):238-42. DOI: 10.1136/neurintsurg-2013-010691. View

Mollan S, Hoffmann J, Sinclair A . Advances in the understanding of headache in idiopathic intracranial hypertension. Curr Opin Neurol. 2018; 32(1):92-98. PMC: 6343949. DOI: 10.1097/WCO.0000000000000651. View

Ahmed R, WILKINSON M, Parker G, Thurtell M, Macdonald J, McCluskey P . Transverse sinus stenting for idiopathic intracranial hypertension: a review of 52 patients and of model predictions. AJNR Am J Neuroradiol. 2011; 32(8):1408-14. PMC: 7964366. DOI: 10.3174/ajnr.A2575. View

Radvany M, Solomon D, Nijjar S, Subramanian P, Miller N, Rigamonti D . Visual and neurological outcomes following endovascular stenting for pseudotumor cerebri associated with transverse sinus stenosis. J Neuroophthalmol. 2013; 33(2):117-22. DOI: 10.1097/WNO.0b013e31827f18eb. View

10.

Ferro J, Coutinho J, Dentali F, Kobayashi A, Alasheev A, Canhao P . Safety and Efficacy of Dabigatran Etexilate vs Dose-Adjusted Warfarin in Patients With Cerebral Venous Thrombosis: A Randomized Clinical Trial. JAMA Neurol. 2019; 76(12):1457-1465. PMC: 6724157. DOI: 10.1001/jamaneurol.2019.2764. View

11.

Skau M, Brennum J, Gjerris F, Jensen R . What is new about idiopathic intracranial hypertension? An updated review of mechanism and treatment. Cephalalgia. 2006; 26(4):384-99. DOI: 10.1111/j.1468-2982.2005.01055.x. View

12.

Bai C, Xu Y, Zhou D, Ding J, Yang Q, Ding Y . The comparative analysis of non-thrombotic internal jugular vein stenosis and cerebral venous sinus stenosis. J Thromb Thrombolysis. 2019; 48(1):61-67. DOI: 10.1007/s11239-019-01820-1. View

13.

Aguiar de Sousa D, Lucas Neto L, Canhao P, Ferro J . Recanalization in Cerebral Venous Thrombosis. Stroke. 2018; 49(8):1828-1835. DOI: 10.1161/STROKEAHA.118.022129. View

14.

Romanelli R, Nolting L, Dolginsky M, Kym E, Orrico K . Dabigatran Versus Warfarin for Atrial Fibrillation in Real-World Clinical Practice: A Systematic Review and Meta-Analysis. Circ Cardiovasc Qual Outcomes. 2016; 9(2):126-34. DOI: 10.1161/CIRCOUTCOMES.115.002369. View

15.

Frisen L . Swelling of the optic nerve head: a staging scheme. J Neurol Neurosurg Psychiatry. 1982; 45(1):13-8. PMC: 491259. DOI: 10.1136/jnnp.45.1.13. View

16.

Rajpal S, Niemann D, Turk A . Transverse venous sinus stent placement as treatment for benign intracranial hypertension in a young male: case report and review of the literature. J Neurosurg. 2005; 102(3 Suppl):342-6. DOI: 10.3171/ped.2005.102.3.0342. View

17.

Li K, Ren M, Meng R, Ding Y, Rajah G, Wang F . Efficacy of stenting in patients with cerebral venous sinus thrombosis-related cerebral venous sinus stenosis. J Neurointerv Surg. 2018; 11(3):307-312. DOI: 10.1136/neurintsurg-2018-014328. View

18.

Peng K, Fuh J, Wang S . High-pressure headaches: idiopathic intracranial hypertension and its mimics. Nat Rev Neurol. 2012; 8(12):700-10. DOI: 10.1038/nrneurol.2012.223. View

19.

Koupenova M, Kehrel B, Corkrey H, Freedman J . Thrombosis and platelets: an update. Eur Heart J. 2017; 38(11):785-791. PMC: 11110018. DOI: 10.1093/eurheartj/ehw550. View

20.

Jakimovski D, Zivadinov R . Use of patient-reported data in determining factors contributing to internal jugular vein stenosis outcomes. Ann Transl Med. 2020; 8(7):421. PMC: 7210184. DOI: 10.21037/atm.2020.03.34. View