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Original research
Predicting the need for retreatment in venous sinus stenting for idiopathic intracranial hypertension
  1. Joshua Kahan1,
  2. Sri Sundararajan2,
  3. Kenroy Brown2,
  4. Marc Dinkin1,
  5. Cristiano Oliveira1,
  6. Athos Patsalides2
  1. 1 Department of Neurology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
  2. 2 Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
  1. Correspondence to Dr Athos Patsalides, Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA; athos.patsalides{at}icloud.com

Abstract

Background Idiopathic intracranial hypertension is a disease of raised intra-cranial pressure of unknown etiology. Lateral cerebral venous sinus stenosis (VSS) has been increasingly reported in these patients, and stenting has emerged as an alternative treatment for medically refractory symptoms. Treatment efficacy on meta-analysis appears promising, but identifying which patients are likely to benefit most, and which are likely to require repeat procedures, is currently unclear.

Methods We retrospectively reviewed a prospectively collected database of 79 patients treated with venous sinus stenting at a single academic center with minimum follow-up of 18 months. We extracted baseline clinical data, as well as manometry at lumbar puncture and during angiography, and used logistic regression to identify parameters that could predict stent failure.

Results Retreatment rate after successful VSS was 13.9%. Lumbar puncture opening pressure (OP) was shown to significantly predict treatment failure (ß=0.06; OR=1.064 (1.003–1.135); P=0.039). This effect remained significant when age, sex and body mass index were added to the model (ß=0.06; OR=1.066 (1.002–1.140); P=0.043). OP was correlated with venous sinus manometry readings in the superior sagittal and transverse sinus pre-stent placement, as well trans-stenotic gradient (P<0.001).

Conclusions Higher lumbar puncture OP was associated with an increased risk of stent failure in transverse sinus stenting for idiopathic intracranial hypertension, although the performance of this model as a linear discriminator was poor. Further studies are required to better assess which patients are at greatest risk of treatment failure.

  • intracranial pressure
  • stent
  • stenosis
  • intervention
  • angioplasty

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Twitter @joshjkahan

  • Contributors JK and AP designed the study. KB, SS, MD, CO and AP collected the data and provided critical appraisal of the manuscript. JK, MD and AP wrote the manuscript.

  • 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.

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

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