Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053, China.
BMC Neurol. 2022 Jun 6;22(1):209. doi: 10.1186/s12883-022-02731-0.
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.
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.
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.
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.
目前关于脑静脉窦狭窄（CVSS）支架置入后管理的策略并不一致。在此，我们比较了口服抗凝剂（OACs）联合单一抗血小板治疗与双联抗血小板治疗在 CVSS 支架置入后的安全性和疗效。
这是一项从 2009 年 1 月至 2019 年 10 月进行的真实世界观察性研究，纳入了诊断为 CVSS 并接受支架置入的患者。根据支架置入后的治疗方法，患者被分为两组。组 1：OACs 联合单一抗血小板药物（氯吡格雷 75mg 或阿司匹林 100mg）；组 2：双联抗血小板治疗（氯吡格雷 75mg 加阿司匹林 100mg）。比较两组的安全性（如主要或次要出血或静脉血栓形成）和疗效（脑静脉窦再狭窄、支架内血栓形成或支架移位的发生率）。
最终分析共纳入 110 例符合条件的患者，其中 79 例为女性，31 例为男性，平均年龄为 43.42±13.23 岁。两组均未发生主要出血或静脉血栓形成。组 2 发生 2 例轻微出血事件（1 例为双下肢皮下出血点，1 例为口腔黏膜下出血），组 1 未发生出血事件。此外，在 1 年随访时，组 2 发生 1 例腔内再狭窄和 2 例支架内血栓形成，组 1 无此类事件发生。支架置入后 1 年内，两组均未发现支架相邻节段狭窄或支架移位。
OACs 联合单一抗血小板治疗与双联抗血小板治疗单独应用均是 CVSS 支架置入后安全有效的治疗策略，前者在抑制支架内血栓形成方面可能优于后者。然而，需要更大规模、多中心的临床试验进一步研究。
