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Braided Versus Laser-Cut Stents in Venous Sinus Stenting for Pulsatile Tinnitus: A Systematic Review and
Alperen Elek1, Gulfem Dindar2, Cem Bilgin2
1From the Faculty of Medicine (A.E.), Ege University, Izmir, Türkiye; Faculty of Medicine (G.D.), Gazi University, Ankara, Türkiye; Department of Radiology (C.B., R.K., D.F.K., W.B.), Mayo Clinic, Rochester, MN, USA and Department of Graduate Medical Education (A.H.), Valley Health System, Las Vegas, NV, USA alperenelek13@gmail.com.
Background:
Venous sinus stenting (VSS) is a treatment option for patients with pulsatile tinnitus (PT); however, comparative outcome data between braided and laser-cut stent designs remain limited.
Materials And Methods:
A systematic literature search of MEDLINE, Web of Science, and Scopus was conducted in accordance with PRISMA guidelines. Pooled analyses were performed using random-effects models with generalized linear mixed-effects modeling for proportional outcomes. Subgroup analyses were conducted according to stent design (braided versus laser-cut) and etiology (idiopathic intracranial hypertension (IIH) versus isolated PT).
Results:
Forty studies comprising 995 patients were included. Overall, PT recurrence occurred in 7.77% of patients (95% CI 4.71-12.55), complete resolution was achieved in 91.59% (95% CI 82.85-96.09), and symptomatic improvement was reported in 91.42% (95% CI 86.63-94.60). The overall complication rate was 3.57% (95% CI 1.68-7.43). In stent-type subgroup analyses, improvement rates were 91.78% for braided stents (95% CI 81.40-96.61) and 93.27% for laser-cut stents (95% CI 85.15-97.10; P = 0.74). Complete resolution was achieved in 89.51% of patients treated with braided stents (95% CI 76.52-95.72) and 89.04% of those treated with laser-cut stents (95% CI 67.97-96.88; P = 0.95). Recurrence rates were 7.20% for braided stents (95% CI 2.72-17.72) and 7.91% for laser-cut stents (95% CI 3.54-16.73; P = 0.881), while complication rates were 3.24% (95% CI 0.81-12.07) and 3.63% (95% CI 1.14-10.95), respectively (P = 0.89). When stratified by etiology, improvement rates were 90.91% in IIH and 96.57% in isolated PT (P = 0.32), while complete resolution was achieved in 91.90% and 98.81%, respectively (P = 0.22). Recurrence rates were 8.08% (95% CI 4.64-13.69) in IIH and 2.43% (95% CI 0.32-16.24) in isolated PT (P = 0.24), and complication rates were 3.99% (95% CI 1.92-8.31) in IIH and 0.30% (95% CI 0.00-76.62) in isolated PT (P = 0.46), with no statistically significant differences detected between groups.
Conclusions:
VSS is associated with high rates of symptom improvement and low complication rates in patients with PT, with no significant differences in clinical outcomes between braided and laser-cut stents or between IIH and isolated PT.
