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Original research
Dural sinus stenting for idiopathic intracranial hypertension: factors associated with hemodynamic failure and management with extended stenting
  1. David A Kumpe1,2,
  2. Joshua Seinfeld2,
  3. Xianchen Huang1,3,
  4. Quelin Mei1,4,
  5. David E Case2,
  6. Christopher D Roark2,
  7. Prem S Subramanian2,5,
  8. Kimberly E Lind1,
  9. Victoria S Pelak5,6,
  10. Jeffrey L Bennett5,6
  1. 1Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
  2. 2Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
  3. 3Department of Interventional Radiology and Vascular Surgery, Suzhou Municipal Hospital, Suzhou, China
  4. 4Department of Interventional Radiology, Nanfang Hospital, Guangzhou, China
  5. 5Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
  6. 6Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
  1. Correspondence to Dr David A Kumpe, Department of Radiology and Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; david.kumpe{at}ucdenver.edu

Abstract

Background Some patients undergoing dural sinus stenting for idiopathic intracranial hypertension (IIH) develop clinical and hemodynamic failure (recurrence of the pressure gradient) owing to stent-adjacent stenosis.

Objective To characterize factors associated with hemodynamic failure, and to describe outcomes of patients after repeat stenting.

Materials and methods We reviewed the initial and follow-up clinical, venographic, and hemodynamic data in 39 patients with IIH treated over 17 years with stenting. Thirty-two had follow-up angiographic and hemodynamic data at 1–99 months (mean 27.6, median 19.5 months). Eight patients were treated with 12 repeat stenting procedures, including extended stenting into the superior sagittal sinus (SSS).

Results All patients had an initial successful hemodynamic result with the pressure gradient reduced from 10–43 to 0–7 mm Hg. 10/32 patients (31.3%), all women, developed new stenoses in the transverse sinus or posterior SSS above the stent with a recurrent pressure gradient. 7/9 patients with pure extrinsic stenosis of the transverse-sigmoid junction pre-stenting developed new stenoses and hemodynamic failure. All patients with hemodynamic failure who were restented had early and mid-term documented hemodynamic success at 1.7–50 months. They were free from papilledema at 3.8–50 months after the last restenting, and 11.5–99.5 months after initial stent placement (mean 45.3, median 38.5 months).

Conclusions 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.

  • Intervention
  • Intracranial Pressure
  • Stenosis
  • Stent
  • Vein

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Footnotes

  • Contributors Data acquisition and interpretation: DAK, JS, XH, QM, DEC, CDR, PSS, KEL, VSP, JLB. Drafting article: DAK, XH, DEC. Statistical analysis: KEL. Critical revision of article: DAK, QM, DEC, CDR, PSS, KEL, VSP, JLB. Reviewed manuscript as submitted: DAK, JS, XH, QM, DEC, CDR, PSS, KEL, VSP, JLB. Study supervisor: DAK.

  • Competing interests None declared.

  • Ethics approval Colorado multi-institutional review board.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data sharing statement The authors agree to share any data on request. Any data from this study are available by contacting the corresponding author.

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