Technical and clinical success after venous sinus stenting for treatment of idiopathic intracranial hypertension using a novel guide catheter for access: Case series and initial multi-center experience

Abstract

Introduction Venous sinus stenting is a well established alternative to cerebrospinal fluid diversion for the treatment of idiopathic intracranial hypertension (IIH) with associated venous sinus stenosis. During this procedure, distal guide catheter placement within the venous sinuses may be desirable to facilitate stent delivery. We report our initial experience using the TracStar LDP™ (Imperative Care, Campbell, USA, 0.088-inch inner diameter) as the guide catheter for intracranial access during venous sinus stenting. Methods A multi-institutional retrospective chart review of a prospectively maintained IRB-approved database was performed. Consecutive patients who underwent venous sinus stenting from 1/1/2020-9/6/2021 for IIH were included. Patient characteristics, procedural details, TracStar distal reach, outcomes, and complications were collected and analyzed. Results Fifty-eight patients were included. The mean age was 33.8 years and 93.1% of patients were female. Visual changes prompted evaluation in 86.2% of patients. Stent placement was successful in all patients. The TracStar LDP catheter was advanced to the location of stent placement in 97.9% of cases in which it was attempted. The large 0.088-inch inner diameter lumen enabled compatibility with all desired stent sizes ranging from six to 10 millimeters. Gradient pressure across transverse sinus stenosis dropped from an average of 19.5 mmHg pre-procedure to 1.7 mmHg post-stent placement (p < 0.001). Clinical improvement was achieved in 87.9% (51/58) of patients. There were no catheter-related complications. Conclusion The TracStar LDP is a safe and effective access platform for reaching treatment locations in patients who present with idiopathic intracranial hypertension and who are candidates for venous sinus stent placement.

Use of a large-bore 088 intracranial access support catheter for delivery of large intracranial devices: case series with the TracStar LDP in 125 cases

“…In this retrospective review of prospective cases, we also describe the use of the TracStar LDP for the delivery of large distal VRDs for the management of venous sinus stenosis. 23 A single case series of 58 patients exists that describes the successful use of the TracStar LDP for venous sinus stenting. 23 In a biaxial platform, the TracStar LDP was navigated to the transverse sinus for the deployment of VRDs as large as 10 mm in diameter.…”

“…23 A single case series of 58 patients exists that describes the successful use of the TracStar LDP for venous sinus stenting. 23 In a biaxial platform, the TracStar LDP was navigated to the transverse sinus for the deployment of VRDs as large as 10 mm in diameter. 23 In the series described here, the TracStar LDP catheter was positioned in the transverse sinus in two cases to deliver the 8×40 mm Precise Pro RX (Cordis, Miami Lakes, Florida, USA) with a triaxial system.…”

“…23 In a biaxial platform, the TracStar LDP was navigated to the transverse sinus for the deployment of VRDs as large as 10 mm in diameter. 23 In the series described here, the TracStar LDP catheter was positioned in the transverse sinus in two cases to deliver the 8×40 mm Precise Pro RX (Cordis, Miami Lakes, Florida, USA) with a triaxial system. Enhanced stability was achieved in both cases by using a triaxial system and was performed without procedural complications.…”

Dural venous sinus stenting technique for idiopathic intracranial hypertension in patients with tortuous venous anatomy

“…[6][7][8][9][10][11] However, placing a straight, minimally exible stent in the tortuous venous system can be challenging, and several techniques have been reported to address this issue. [12][13][14][15][16][17][18][19][20][21][22] To the best of our knowledge this is the rst study to examine the bene ts of using a peripheral vascular stent with a 6 French cervical short sheath and a 0.035-inch Rosen wire for stent deployment via cervical or brachial access. Our clinical outcomes with this approach seem consistent with the literature with several potential technical advantages and simpli cation.…”

“…This is due to the limitations of the commonly used 0.014-inch wire, which can oppose outside turns and worsen the acute angles. [12][13][14][15][16][17][18][19][20][21][22] There is a clear need for alternative approaches to overcome these technical challenges. In this study, we propose a new technique using cervical access and a peripheral vascular stent with a more stable 0.035-inch delivery platform to simplify the procedure and mitigate issues of catheter prolapse associated with femoral access.…”