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Review
Recommendations for the selection and treatment of patients with idiopathic intracranial hypertension for venous sinus stenting
  1. Kyle M Fargen1,
  2. Kenneth Liu2,
  3. Rebecca M Garner1,
  4. Garret P Greeneway1,
  5. Stacey Q Wolfe1,
  6. R Webster Crowley3
  1. 1 Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  2. 2 Department of Neurosurgery, Penn State College of Medicine, Hershey, Pennsylvania, USA
  3. 3 Department of Neurosurgery, Rush Medical College, Chicago, Illinois, USA
  1. Correspondence to Dr Kyle M Fargen, WakeForest University School of Medicine, Winston-Salem, NC 27013, USA; kfargen{at}wakehealth.edu

Abstract

Introduction Although venous sinus stenting (VSS) has emerged as a promising treatment option for patients with idiopathic intracranial hypertension (IIH) and associated venous sinus stenosis, there is considerable ambiguity regarding patient selection criteria, treatment protocols, and management strategies.

Methods An extensive literature review was performed to identify all reports of VSS in patients with IIH using PubMed. Recommendations for the selection and treatment of patients with IIH with VSS are outlined as determined based on author opinion from supporting studies. Due to the lack of randomized trials and few published prospective studies, standard grading scales for recommendations and level of evidence are not fully applicable and therefore a revised grading scale has been provided for recommendations.

Results The literature review identified a total of eight systematic reviews or meta-analyses and 29 published patient series on VSS. Recommendations for patient selection for diagnostic catheter angiography, angiography procedural considerations, stenting procedural considerations, and retreatment are provided based on the literature. Recommendations that were considered strong included: performance of venous sinus manometry to assess candidacy for treatment prior to stenting; administration of antiplatelet agents prior to stenting and for a follow-up period of at least 3–6 months; performance of post-stenting manometry to confirm resolution of pressure gradient; and performance of repeat angiography and manometry on patients with recurrence of symptoms after resolution with stenting to evaluate for recurrent stenosis.

Conclusion VSS for patients with IIH with venous sinus stenosis is now an established and effective treatment option. These recommendations have been provided, based on a summative review of the available published literature, to assist in standardizing care for patients with IIH undergoing VSS.

  • angiography
  • stent

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Footnotes

  • Contributors KMF: conception, study design, data collection, data analysis, manuscript preparation. KL: data analysis, manuscript preparation. RMG: data collection, data analysis, manuscript preparation. GPG: data collection, data analysis, manuscript preparation. SQW: conception, design, data collection, manuscript preparation. RWC: data analysis, manuscript preparation.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

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

  • Data sharing statement There are no unpublished data available.

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