Comparing open and closed cell stents in idiopathic intracranial hypertension: A comprehensive meta-analysis of clinical outcomes

Background: Open cell stents (OC) and closed cell stents (CC) each offer unique advantages and potential drawbacks in the context of idiopathic intracranial hypertension (IIH) treatment. We aim to investigate the safety and efficacy of using OC and CC for IIH. Methods: We conducted a systematic review in PubMed, Embase, and Cochrane Library databases following the PRISMA guidelines. Eligible studies included ≥4 patients with IIH treated by OC or CC. Primary outcomes were headache, visual acuity, and papilledema status before and after the procedure. Additionally, failure rate, minor complications, major complications, and total complications were assessed. Pooled analysis of the OC group and CC group were done separately and then compared. Results: Twenty-four studies were included. Of these, 20 reported on OC and 6 reported on CC. Pooled analysis of failure rate was 8% (4%–12%) in OC and 5% (0%–11%) in CC. For headache improvement rate: 78% (70%–86%) in OC and 81% (66%–69%) in CC. For visual acuity improvement: 78% (65%–92%) in OC and 76% (29%–100%) in CC. For papilledema improvement: 88% (77%–98%) in OC and 82% (67%–98%) in CC. For minor complications: 0% (0%–1%) in OC and 0% (0%–2%) in CC. For major complications: 0% (0%–1%) in OC and 2% (0%–6%) in CC. Total complications: 0% (0%–1%) in OC and 2% (0%–6%) in CC. Conclusion: Low failure and complication rates were found in both OC and CC, with no significant difference between them in effectiveness. The CC showed a slight but significant increase in major and total complications compared to the OC. Additionally, a subtle yet significantly lower failure rate was identified in the CC.