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The use of stents with varying porosity for treating cerebral aneurysms requires dual antiplatelet therapy (DAPT) without clear guidelines on the utility of platelet function tests (PFT) and duration of DAPT.Determine the effect of stent porosity, PFT utilization, and DAPT duration on radiographic and clinical outcomes after stenting of cerebral aneurysms.PubMed was searched on March 29, 2021 for studies of cerebral aneurysm stenting which specify stent type and DAPT duration. A random-effects meta-analysis measured the prevalence of non-procedural thrombotic and hemorrhagic events, clinical outcome, aneurysm occlusion, and in-stent stenosis based on stent-porosity, PFT use, and DAPT duration.The review yielded 105 articles (89 retrospective, 16 prospective) with 117 stenting cohorts (50 high-porosity, 17 intermediate-porosity, and 50 low-porosity). In these stenting cohorts, PFT utilization was 26.0%, 47.1%, and 62.0% and mean DAPT duration was 3.51 (SD=2.33), 3.97 (SD=1.92), and 5.18 (SD=2.27) months, respectively. Intermediate-porosity stents showed reduced hemorrhagic events (π=0.32%) compared to low-porosity stents (π=1.36%; p=.01), and improved aneurysm occlusion (π=6.18%) compared to high (π=14.42%; p=.001) and low-porosity stents (π=11.71%; p=.04). The prevalence of in-stent stenosis was lower for intermediate-porosity (π=0.57%) and high-porosity (π=1.51%) versus low-porosity stents (π=3.30%; p.05). PFT use showed less poor clinical outcomes (π=3.54%) compared to those without PFT (π=5.94%; p=.04). DAPT duration had no effect on the outcomes.In this meta-analysis selecting for studies of cerebral aneurysm stenting that report DAPT duration, intermediate-porosity stents and PFT use had significantly improved outcomes. No effect of DAPT duration could be detected. |
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