Generic placeholder image

Current Neurovascular Research

Author(s): Yaoming Xu, Ran Meng, Gary B. Rajah, Yuchuan Ding, Yan Wu, Yali Wu, Kangxiang Ji, Chuanjie Wu, Wenbo Zhao and Xunming Ji*

DOI: 10.2174/1567202616666190206185133

DownloadDownload PDF Flyer Cite As
Long-term Outcomes of Cerebral Venous Sinus Stenosis Corrected by Stenting

Page: [77 - 81] Pages: 5

  • * (Excluding Mailing and Handling)

Abstract

Background and Purpose: Cerebral Venous Sinus Stenosis (CVSS) usually results in severe Intracranial Hypertension (IH), which can be corrected by stenting immediately. However, there is a lack of evidence of the long-term good outcomes in patients with CVSS who underwent stenting.

Methods: A total of 62 patients with imaging confirmed non-thrombotic and non-external compression CVSS were enrolled into this single center real-world cohort study after undergoing stenting, and were continuously followed up for more than 12 years. The symptoms and signs of IH prior to stenting and post-stenting and the incidence of restenosis after stenting were analyzed.

Results: The mean age of the 62 patients (range, 13 to 62) was 40 years old, and the mean body mass index was 26 (range 23 to 40). Females accounted for 67.7% (42/62). Headache was the most common symptom (79%). Transient visual obscurations occurred in 69% of the patients. 42% of the patients suffered from visual loss, 11.3% pulsatile tinnitus, and 96.8% Papilledema before stenting. The mean trans-stenotic pressure gradients were 6~43 mmHg prior to stenting and returned to 0~4 mmHg after stent placement. During the following 12~126 months (the median was 62) after stenting of the follow-up, 91.9% (57/62) of the patients obtained good outcomes. Headaches disappeared in 96% (47/49) of the patients and papilledema was attenuated in 98.3% (59/60). However, There were still 8.0 % (5/62) of the patients with poor outcomes, including optic disc atrophy in 3 patients and stent-interior thrombosis in 2 patients, which occurred 6.3 months after stenting.

Conclusion: Our data suggest that stenting may be a promising therapy for CVSS correcting. Patients with CVSS may get long-term benefit from stenting, especially when they are accompanied with severe IH.

Keywords: Cerebral Venous Sinus Stenosis (CVSS), stenting, long-term outcome, Intracranial Hypertension (IH), therapy, papilledema.

[1]
Bai C, Xu Y, Zhou D, et al. The comparative analysis of non-thrombotic internal jugular vein stenosis and cerebral venous sinus stenosis. J Thromb Thrombol 2019.
[http://dx.doi.org/10.1007/s11239-019- 01820-1.]
[2]
Li K, Ren M, Meng R, et al. Efficacy of stenting in patients with cerebral venous sinus thrombosis-related cerebral venous sinus stenosis. J Neurointerv Surg 2019; 11(3): 307-12.
[3]
Albuquerque FC, Dashti SR, Hu YC, et al. Intracranial venous sinus stenting for benign intracranial hypertension: Clinical indications, technique, and preliminary results. World Neurosurg 2011; 75(5-6): 648-52. discussion 592-645.
[4]
Kumpe DA, Bennett JL, Seinfeld J, Pelak VS, Chawla A, Tierney M. Dural sinus stent placement for idiopathic intracranial hypertension. J Neurosurg 2012; 116(3): 538-48.
[5]
Ahmed RM, Wilkinson M, Parker GD, et al. Transverse sinus stenting for idiopathic intracranial hypertension: A review of 52 patients and of model predictions. AJNR Am J Neuroradiol 2011; 32(8): 1408-14.
[6]
Patsalides A, Oliveira C, Wilcox J, et al. Venous sinus stenting lowers the intracranial pressure in patients with idiopathic intracranial hypertension. J Neurointerv Surg 2019; 11(2): 175-8.
[7]
Gross BA, Albuquerque FC, Moon K, McDougall CG. New frontiers in venous sinus stenting: Illustrative cases. J Clin Neurosci 2016; 33: 241-4.
[8]
King JO, Mitchell PJ, Thomson KR, Tress BM. Cerebral venography and manometry in idiopathic intracranial hypertension. Neurology 1995; 45(12): 2224-8.
[9]
Frisen L. Swelling of the optic nerve head: A backstage view of a staging scheme. J Neuroophthalmol 2017; 37(1): 3-6.
[10]
Miyachi S, Hiramatsu R, Ohnishi H, Takahashi K, Kuroiwa T. Endovascular treatment of idiopathic intracranial hypertension with stenting of the transverse sinus stenosis. Neurointervention 2018; 13(2): 138-43.
[11]
Shields LBE, Shields CB, Yao TL, Plato BM, Zhang YP, Dashti SR. Endovascular treatment for venous sinus stenosis in idiopathic intracranial hypertension: An observational study of clinical indications, surgical technique, and long-term outcomes. World Neurosurg 2019; 121: e165-71.
[12]
Friedman DI, Jacobson DM. Diagnostic criteria for idiopathic intracranial hypertension. Neurology 2002; 59(10): 1492-5.
[13]
Leach JL, Jones BV, Tomsick TA, Stewart CA, Balko MG. Normal appearance of arachnoid granulations on contrast-enhanced ct and mr of the brain: Differentiation from dural sinus disease. AJNR Am J Neuroradiol 1996; 17(8): 1523-32.
[14]
Brazis PW. Clinical review: The surgical treatment of idiopathic pseudotumour cerebri (idiopathic intracranial hypertension). Cephalalgia 2008; 28(12): 1361-73.
[15]
Satti SR, Leishangthem L, Chaudry MI. Meta-analysis of csf diversion procedures and dural venous sinus stenting in the setting of medically refractory idiopathic intracranial hypertension. AJNR Am J Neuroradiol 2015; 36(10): 1899-904.
[16]
Raper D, Buell TJ, Ding D, Chen CJ, Starke RM, Liu KC. Pattern of pressure gradient alterations after venous sinus stenting for idiopathic intracranial hypertension predicts stent-adjacent stenosis: A proposed classification system. J Neurointerv Surg 2018; 10(4): 391-5.
[17]
Tsumoto T, Miyamoto T, Shimizu M, et al. Restenosis of the sigmoid sinus after stenting for treatment of intracranial venous hypertension: Case report. Neuroradiology 2003; 45(12): 911-5.
[18]
Satti SR, Leishangthem L, Spiotta A, Chaudry MI. Dural venous sinus stenting for medically and surgically refractory idiopathic intracranial hypertension. Interv Neuroradiol 2017; 23(2): 186-93.
[19]
Fields JD, Javedani PP, Falardeau J, et al. Dural venous sinus angioplasty and stenting for the treatment of idiopathic intracranial hypertension. J Neurointerv Surg 2013; 5(1): 62-8.
[20]
Buell TJ, Raper DM, Ding D, Chen CJ, Liu KC. Development of an intracranial dural arteriovenous fistula after venous sinus stenting for idiopathic intracranial hypertension. J Neurointerv Surg 2018; 10(7): e15.