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Original research
Pattern of pressure gradient alterations after venous sinus stenting for idiopathic intracranial hypertension predicts stent-adjacent stenosis: a proposed classification system
  1. Daniel Raper1,
  2. Thomas J Buell1,
  3. Dale Ding1,
  4. Ching-Jen Chen1,
  5. Robert M Starke2,
  6. Kenneth C Liu1,3
  1. 1 Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
  2. 2 Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
  3. 3 Department of Radiology, University of Virginia Health System, Charlottesville, Virginia, USA
  1. Correspondence to Dr Daniel Raper, Department of Neurosurgery, University of Virginia Health System, Box 800212, Charlottesville, VA 22908, USA; raper{at}


Objective Venous sinus stenting (VSS) is a safe and effective treatment for idiopathic intracranial hypertension (IIH) with angiographic venous sinus stenosis. However, predictors of stent-adjacent stenosis (SAS) remain poorly defined.

Methods We performed a retrospective review of 47 patients with IIH and intracranial venous stenosis who underwent VSS with pre- and post-stent venography. Patient characteristics, treatments and outcomes were reviewed. Changes in pressure gradient after VSS were classified according to pattern of gradient resolution into types I–III.

Results Type I gradient resolution, in which mean venous pressure (MVP) in the transverse sinus (TS) decreases towards MVP in the sigmoid sinus (SS), occurred in 18 patients (38.3%). Type II gradient resolution pattern, in which SS MVP increases towards that in the TS, occurred in 7patients (14.9%). Type III pattern, in which MVP equilibrates to a middle value, occurred in 22patients (46.8%). SAS occurred in 0%, 28.6%, and 22.7% of patients in types I, II and III, respectively. Compared with patients with type I gradient resolution, SAS was more common in those with type II (p=0.0181) and type III (p=0.0306) patterns.

Conclusions The pattern of change in the trans-stenosis venous pressure gradient may be predictive of SAS and is a useful tool for classifying the response of the venous obstruction to stenting. A type I pattern appears to represent the ideal response to VSS. Some patients with type II and III changes, particularly if they have other predictors of recurrent stenosis, may benefit from longer initial stent constructs.

  • Intracranial pressure
  • stenosis
  • stent
  • vein

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  • Contributors DR conceived the study, performed data analysis, drafted the manuscript and approved the final version. TJB and DD assisted in data analysis, critically revised the manuscript and approved the final version. C-JC and RMS critically revised the manuscript and approved the final version. KCL contributed to the design of the study, oversaw data collection and analysis, critically revised the manuscript, and approved the final version.

  • Competing interests None.

  • Ethics approval Ethics approval was obtained from the University of Virginia Institutional Review Board for Health Sciences Research prior to the initiation of this study.

  • Provenance and peer review Not commissioned; externally 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.