Dural sinus stenting for idiopathic intracranial hypertension: factors associated with hemodynamic failure and management with extended stenting

Abstract

Pure extrinsic compression of the transverse-sigmoid junction and female gender were strongly associated with hemodynamic failure. Eight patients with hemodynamic failure who were restented had successful control of papilledema, including 4/4 who had extended stenting into the SSS.

Venous sinus stenting for idiopathic intracranial hypertension: a systematic review and meta-analysis

“…These recurrences were treated with another stent in 72.8% of those patients, while a CSF diversion procedure was performed in 27.2%. Recurrence seems to preferentially affect young obese patients with extrinsic stenoses and high CSF opening-pressures and is usually related to a de-novo stenosis outside the stented portion of the sinus 18. This supports the pathophysiological hypothesis of formation of extrinsic stenoses, suggesting that these stenoses are caused by compression of the transverse sinus by the congested brain and CSF spaces against the calvarium.…”

Idiopathic Intracranial Hypertension: Contemporary Management and Endovascular Techniques

“…Ipsilateral NA has been performed to verify that the vein of Labbe remains patent, which is invariably covered by the stent. At our institution, the vein of Labbe remained patent in all studied patients, 9 as also noted by others. 10,11 The frequency of NA follow-up depends on the type of stenosis present initially.…”

“…No male in our experience has had hemodynamic failure. 9 The patient group which most commonly has extrinsic stenosis are young obese female patients. Our current experience suggests that these patients, even with stenting of the entire transverse through upper sigmoid sinuses, are likely to develop hemodynamic failure by developing new stenosis in the contralateral transverse sinus and the posterior SSS.…”

Recommendations for the selection and treatment of patients with idiopathic intracranial hypertension for venous sinus stenting

“…A similar study by Goodwin et al also showed that patients with a higher opening pressure were associated with needing a shunt placement post venous sinus stenting 32. In addition, Kumpe et al showed that patients with higher mean opening pressures were also more likely to have hemodynamic failure and require retreatment 37. It remains uncertain what specific angiographic findings or stenting outcomes can be elucidated from higher mean opening pressures.…”

“…Mekabaty et al found that the need for retreatment was correlated with BMI 40. Kumpe et al reported that the need for retreatment was correlated with female gender, younger age, and higher opening lumbar pressures 37. Therefore, there is evidence to indicate that the need for retreatment is correlated with certain risk factors such as BMI, increased pre-stent intracranial pressure, and age.…”