Background Venous sinus stenting is an effective treatment for papilledema associated with idiopathic intracranial hypertension (IIH). It is unclear whether unilateral transverse-sigmoid sinus (TSS) stenting adequately decompresses the contralateral TSS system in cases of bilateral transverse sinus stenosis. The objective of this study was to compare changes in bilateral TSS pressure gradients following unilateral TSS stenting in a series of patients with IIH.
Methods Consecutive patients from a single institution who underwent venous sinus stenting for IIH with measurement of bilateral pressure gradients before and after stenting for IIH were enrolled. Pressure gradients in both TSS pre- and post-stenting were measured during the procedure. The TSS with the highest gradient was stented. Changes in TSS pressure gradients following stent placement were calculated for both TSS. Mean changes in pressure gradients of ipsilateral and contralateral TSS were calculated.
Results Sixteen patients with IIH who underwent TSS stenting were included. All were female. Mean age was 36.4 years. The right-sided TSS was the stented side in 12 (75.0%) patients. The mean pre-stent pressure gradient of the ipsilateral TSS was 19.3 mmHg (SD=10.8), which was reduced to a mean of 3.8 mmHg (3.4) following stent placement (P =<0.0001). On the contralateral (non-stented) side, the mean pre-stent gradient of 15.1 mmHg (7.5) was reduced to a mean of 7.8 mmHg (6.6) following stenting (P=0.006).
Conclusions The use of a single stent provides some venous decompression of the contralateral non-stented stenosis in most cases of IIH treated with endovascular therapy.
- intracranial pressure
- blood flow
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Contributors Anthony Larson: Data analysis, draft writing, editing, revision, approval of final copy. Lorenzo Rinaldo: Data gathering and analysis, editing, approval of final copy. John Chen: Study design, data gathering and analysis, editing, approval of final copy. Jeremy Cutsforth-Gregory: Study design, data gathering and analysis, editing, approval of final copy. Amy Thieler: Study design, data gathering and analysis, approval of final copy. Waleed Brinjikji: Study design, data gathering and analysis, editing, approval of final copy, revision.
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 for publication Not required.
Ethics approval Institutional review board approval was obtained from Mayo Clinic Institutional Review Board (IRB Approval ID#: #: 20-003065). All patients included in this study provided written informed consent for involvement of research activities at our institution.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Data are stored in a deidentified database that is available upon request. Requests should be submitted to Dr. Waleed Brinjikji at email@example.com.