Effect of Stent Porosity, Platelet Function Test Usage, and Dual Antiplatelet Therapy Duration on Clinical and Radiographic Outcomes After Stenting for Cerebral Aneurysms: A Meta-Analysis

BACKGROUND

The use of stents with various porosities for treating cerebral aneurysms requires dual antiplatelet therapy (DAPT) without clear guidelines on the utility of platelet function tests (PFTs) and the duration of DAPT. We sought to determine the effects of stent porosity, PFT usage, and DAPT duration on the radiographic and clinical outcomes after stenting of cerebral aneurysms.

METHODS

PubMed was searched on March 29, 2021 for studies of cerebral aneurysm stenting that had specified the stent type and DAPT duration. A random effects meta-analysis was used to measure the prevalence of nonprocedural thrombotic and hemorrhagic events, clinical outcomes, aneurysm occlusion, and in-stent stenosis stratified by stent porosity, PFT usage, and DAPT duration.

RESULTS

The review yielded 105 studies (89 retrospective and 16 prospective) with 117 stenting cohorts (50 high porosity, 17 intermediate porosity, and 50 low porosity). In the high-, intermediate-, and low-porosity stenting cohorts, PFT usage was 26.0%, 47.1%, and 62.0% and the mean DAPT duration was 3.51 ± 2.33, 3.97 ± 1.92, and 5.18 ± 2.27 months, respectively. The intermediate-porosity stents showed a reduced incidence of hemorrhagic events (π = 0.32%) compared with low-porosity stents (π = 1.36%; P = 0.01) and improved aneurysm occlusion (π = 6.18%) compared with high-porosity stents (π = 14.42%; P = 0.001) and low-porosity stents (π = 11.71%; P = 0.04). The prevalence of in-stent stenosis was lower for the intermediate-porosity (π = 0.57%) and high-porosity (π = 1.51%) stents than for the low-porosity stents (π = 3.30%; P < 0.05). PFT use had resulted in fewer poor clinical outcomes (π = 3.54%) compared with those without PFT use (π = 5.94%; P = 0.04). The DAPT duration had no effect on the outcomes.

CONCLUSIONS

In the present meta-analysis, which had selected for studies of cerebral aneurysm stenting that had reported the DAPT duration, intermediate-porosity stents and PFT use had resulted significantly improved outcomes. No effect of DAPT duration could be detected.

Intraoperative Assessment of Coronal Balance with Long Cassette Radiographs in Adult Thoracolumbar Deformity Correction

BACKGROUND

To describe the use of intraoperative anteroposterior long cassette radiographs (APLCR) to guide kickstand rod application in adult spinal deformity.

METHODS

A retrospective chart review was performed to identify patients with adult thoracolumbar and coronal plane deformity undergoing open segmental decompression with spino-pelvic fixation and deformity correction between October 2017 and June 2019 had APLCR after rod placement. In patients with persistent intraoperative coronal deviations, a Kickstand rod was placed. This supplemental rod was anchored to an iliac screw and to the construct via a pair of side to side connectors. A distractor was expended between a vice grip plyer on the kickstand and side-to-side connector to apply a lateralizing force to reduce the degree of deviation.

RESULTS

A total of 15 patients underwent T3-Ilium fusion with spinal deformity correction with intraoperative APLCR; 7 underwent Kickstand placement. Mean preoperative coronal deviation was similar between cohorts (4.3 cm vs 2.2 cm, p = 0.09), but was greater intraoperatively in the kickstand cohort (4.3 cm vs 0.6 cm, 9 < 0.001). Postoperative coronal deviation was similar between groups (2.1cm vs 1.8cm, p = 0.37). Preoperative fractional lumbar curve was significantly greater in patients requiring kickstand (23˚ vs 35˚, p = 0.02), but major thoracolumbar curve was similar between groups (43˚ vs 35˚, p=0.14).

CONCLUSION

Intraoperative APLCR can help guide application of kickstand in adult thoracolumbar deformity correction. Patients with a greater fractional lumbar curve may derive greater benefit of kickstand usage, independent of major curve magnitude.