Introduction/purpose Evaluate the role of intravascular ultrasound (IVUS) in the cerebral venous sinus angioplasty and stenting.
Materials and methods The study population included all patients treated with dural venous sinus stenting (DVS) at our institution over a 3-year period (January 2012–December 2014). Depending on age and presence of visual symptoms at presentation, the patients were either enrolled in the FDA approved prospective clinical trial of “Venous sinus stenting in patients with idiopathic intracranial hypertension (IIH) refractory to medical therapy” or were enrolled in a prospective patient registry, both approved by our Institutional Review Board.
Patient demographics, clinical presentation, imaging findings and procedural details were obtained from the institutional prospective database (RedCap). Eagle Eye ST (Short Tip) intravenous ultrasound (IVUS) device (Volcano Corporation) was used to measure the maximum luminal diameter of the superior sagittal sinus, proximal transverse sinus, distal transverse sinus stenosis and the sigmoid sinus beyond the stenosis. Similar measurements at identical locations were made on preprocedural MR venography (phase contrast-INHANCE) and digital subtraction angiography (DSA). DSA measurements are obtained under both, the conscious sedation (venous manometry) and general anesthesia (venous sinus stenting). Feasibility of IVUS and technical complications were documented for each procedure. Statistical analysis performed using student t-Test.
Results Twenty patients with 21 procedures of DVS of distal transverse sinus constituted the study population. The mean age of the study population was 27.1 ± 7 years (16–39 years) and 19 out of 20 are female patients. Sixteen patients (n = 16) had DVS on the right side and four patients (n = 4) on the left side.
The measured venous sinus diameters on IVUS are: 6.6 ± 1.5 mm for superior sagittal sinus, 6.3 ± 1.7 mm for proximal transverse sinus, 2.7 ± 0.6 mm for distal transverse stenosis and 7.5 ± 2.5 mm for post stenotic sigmoid sinus. Venous sinus measurements including the stenosis on MR venography (6.7 ± 1.0 mm, 6.2 ± 1.5 mm, 3.1 ± 0.9 mm and 7.7 ± 1.2 mm respectively) are concordant to the IVUS (p = 0.74). The maximum diameter of the stenosis measured on DSA is significantly higher than IVUS, at venous manometry (3.3 ± 1.1 mm; p < 0.05) and venous sinus stenting (4.4 ± 1.8 mm; p < 0.001). The stenosis diameter on DSA is significantly higher (p < 0.01) during general anesthesia (4.4 ± 1.8 mm) compared to the conscious sedation ((3.3 ± 1.1 mm).
Successful DVS was confirmed significant increase in the diameter of the stenosis from 4.4 ± 1.8 mm to 6.8 ± 0.9 mm (p < 0.001), and significant decrease in the proximal transverse-distal sigmoid sinus pressure gradient from 18.7 ± 8.5 mm Hg to 2.7 ± 1.5 mm Hg (p < 0.001).
IVUS was feasible in all our patients, except one where the IVUS probe failed to advance across a severe stenosis from a large arachnoid granulation. IVUS confirmed the accurate localization of the stenosis in all the feasible patients. No technical or procedural complications were encountered in our study cohort. One patient developed re-stenosis at the distal aspect of the initial stent and required re-stenting.
Conclusion In our experience, intravascular ultrasound is a feasible, safe and reliable diagnostic tool; provides valuable supplemental information in the diagnosis and treatment planning of cerebral dural venous sinus stenosis under general anesthesia.
Disclosures S. Boddu: None. M. Crimmins: None. M. Dinkin: None. A. Patsalides: None.
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