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Original research
A pilot study and novel angiographic classification for superior sagittal sinus stenting in patients with non-thrombotic intracranial venous occlusive disease
  1. Daniel M S Raper1,
  2. Thomas J Buell1,
  3. Dale Ding1,
  4. I Jonathan Pomeraniec1,
  5. R Webster Crowley2,
  6. Kenneth C Liu1,3
  1. 1Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
  2. 2Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
  3. 3Department of Radiology, University of Virginia Health System, Charlottesville, Virginia, USA
  1. Correspondence to Dr Thomas J Buell, Department of Neurosurgery, University of Virginia Health System, Box 800212, Charlottesville, VA 22908, USA; tjb4p@hscmail.mcc.virginia.edu

Abstract

Objective Safety and efficacy of superior sagittal sinus (SSS) stenting for non-thrombotic intracranial venous occlusive disease (VOD) is unknown. The aim of this retrospective cohort study is to evaluate outcomes after SSS stenting.

Methods We evaluated an institutional database to identify patients who underwent SSS stenting. Radiographic and clinical outcomes were analyzed and a novel angiographic classification of the SSS was proposed.

Results We identified 19 patients; 42% developed SSS stenosis after transverse sinus stenting. Pre-stent maximum mean venous pressure (MVP) in the SSS of 16.2 mm Hg decreased to 13.1 mm Hg after stenting (p=0.037). Preoperative trans-stenosis pressure gradient of 4.2 mm Hg decreased to 1.5 mm Hg after stenting (p<0.001). No intraprocedural complication or junctional SSS stenosis distal to the stent construct was noted. Improvement in headache, tinnitus, and visual obscurations was reported by 66.7%, 63.6%, and 50% of affected patients, respectively, at mean follow-up of 5.2 months. We divided the SSS into four anatomically equal segments, numbered S1–S4, from the torcula to frontal pole. SSS stenosis typically occurs in the S1 segment, and the anterior extent of SSS stents was deployed at the S1–S2 junction in all but one case.

Conclusions SSS stenting is reasonably safe, may improve clinical symptoms, and significantly reduces maximum MVP and trans-stenosis pressure gradients in patients with VOD with SSS stenosis. The S1 segment is most commonly stenotic, and minimum pressure gradients for symptomatic SSS stenosis may be lower than for transverse or sigmoid stenosis. Additional studies and follow-up are necessary to better elucidate appropriate clinical indications and long-term efficacy of SSS stenting.

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Footnotes

  • DMSR and TJB contributed equally.

  • Contributors All authors made substantial contributions to the conception, data acquisition and analysis, interpretation, or drafting of this research article. We approve this final version to be published. DMSR and TJB contributed equally to this work and are joint first authors.

  • Competing interests None declared.

  • Ethics approval Ethics approval was obtained from the Institutional Review Board of the University of Virginia.

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

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