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Clinical Neurology
Case series
Efficacy of stenting in patients with cerebral venous sinus thrombosis-related cerebral venous sinus stenosis
  1. Ke Li1,2,
  2. Ming Ren1,
  3. Ran Meng3,
  4. Yuchuan Ding4,
  5. Gary B Rajah4,
  6. Feng Wang2,
  7. Xunming Ji1
  1. 1 Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
  2. 2 Department of Interventional Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
  3. 3 Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
  4. 4 Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
  1. Correspondence to Professor Xunming Ji, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; jixm{at}ccmu.edu.cn

Abstract

Background Venous stenting has been proven to be a safe and effective therapeutic option for patients with idiopathic intracranial hypertension (IIH) and cerebral venous sinus stenosis (CVSS). However, its use in patients with cerebral venous sinus thrombosis-related CVSS has been less reported.

Purpose To explore the safety and efficacy of stenting for patients with cerebral venous sinus thrombosis (CVST)-related CVSS.

Methods The clinical presentation, treatment, and outcome of patients with CVST-related CVSS received venous stenting in the chronic stage after failed medical treatment were retrospectively evaluated.

Results A total of 17 patients with CVST-related CVSS were included. Mean pressure gradient across the CVSS decreased from 11.5±4.2 mmHg prior to stenting to 2.1±1.1 mmHg post- stenting. Mean CSF opening pressure decreased from 33.1±5.5 cmH2O to 18.7±1.7 cmH2O. Both headache and visual disturbance improved or resolved in 78% and 92% of the patients, respectively. Complications included lethal cerebellar hematoma in one case and bilateral occipital epidural hematoma in another case. One of the patients received retreatment with ventriculo-peritoneal shunting due to recurrent headache.

Conclusion Restoring the patency of stenotic sinuses with stents in patients of CVST-related CVSS unresponsive to medical therapy in the chronic stage may improve symptoms in the majority of the patients. However, a relatively higher cerebral hemorrhage rate was observed and may be related to this pathology. Stenting in this subgroup of CVSS patients may require further evaluation with a larger and long-term study, and should be used with caution at this time.

  • stent
  • vein
  • stenosis

https://doi.org/10.1136/neurintsurg-2018-014328

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    Footnotes

    • Contributors All authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing, or revision of the manuscript.Conception and design of the study: XJ; KL. Analysis and interpretation of data: RM; FW. Acquisition of data and drafting the article: KL. Revising critically for important intellectual content: MR; GBR; YD. Final approval of the version to be published: XJ.

    • 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.