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Clinical neurology
Original research
Zilver stent versus Carotid Wallstent for endovascular treatment of idiopathic intracranial hypertension
  1. Cem Bilgin1,
  2. Alexander A Oliver2,
  3. Jeremy K Cutsforth-Gregory3,
  4. John J Chen4,
  5. Stylianos K Rammos5,
  6. Harry J Cloft1,
  7. Giuseppe Lanzino6,
  8. David F Kallmes1,
  9. Waleed Brinjikji1
  1. 1 Radiology, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Biomedical Engineering, Mayo Clinic Minnesota, Rochester, Minnesota, USA
  3. 3 Neurology, Mayo Clinic, Rochester, Minnesota, USA
  4. 4 Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
  5. 5 Neurosurgery, Arkansas Neuroscience Institute, Little Rock, Arkansas, USA
  6. 6 Neurosurgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA
  1. Correspondence to Dr Cem Bilgin, Department of Radiology, Mayo Clinic, Rochester 55905, Minnesota, USA; bilgin.cem{at}mayo.edu

Abstract

Background Venous sinus stenting (VSS) is a promising treatment option for medically refractory idiopathic intracranial hypertension (IIH). There are no published studies comparing the performance of different types of stents employed in VSS procedures. In this study we aimed to compare the safety and efficacy outcomes of the Zilver 518 (Cook Medical, Bloomington, Indiana, USA) and the Carotid Wallstent (Boston Scientific, Marlborough, Massachusetts, USA) devices.

Methods Records of patients with IIH who underwent VSS between January 2015 and February 2022 at a single referral center were retrospectively reviewed. Patients treated with the Zilver stent or Carotid Wallstent were included in the study. Stent model and size data, pre- and post-treatment pressure gradients, technical and safety outcomes, and pre- and post- stenting papilledema, headache, and tinnitus severity were collected. The χ2 and Fisher–Freeman–Halton tests were used for categorical data and the Student’s t-test and Mann–Whitney U test were employed to examine the differences in non-categorical variables.

Results A total of 81 procedures (28 (34.5%) with the Zilver stent and 53 (65.5%) with the Carotid Wallstent) were performed in 76 patients. The mean procedure time was significantly shorter with the Zilver stent (22.56±10.2 vs 33.9±15 min, p=0.001). The papilledema improvement and resolution rates did not significantly differ between groups (94.7% vs 94.5%, p>0.99 for improvement; 78.9% vs 67.5%, p=0.37 for resolution). The tinnitus improvement and resolution rates in the Zilver stent group were significantly higher than those of the Carotid Wallstent group (100% vs 78.9%, p=0.041; 90% vs 63.1%, p=0.03, respectively). Additionally, the Zilver stent provided a significantly higher rate of headache resolution and improvement than the Carotid Wallstent (84.6% vs 27.6%, p=0.001 for resolution; 92.3% vs 72.3%, p=0.043 for improvement). One patient from the Carotid Wallstent group underwent re-stenting due to in-stent stenosis and refractory papilledema. No significant in-stent stenosis was observed in the Zilver stent group.

Conclusion Stent choice may affect VSS outcomes. The Zilver stent provided better clinical outcomes than the Carotid Wallstent, with significantly shorter procedure times. Larger studies are needed to determine the efficacy of available venous stents for IIH.

  • Intracranial Pressure
  • Stenosis
  • Stent

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/jnis-2022-019659

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Twitter @CemBilgin__, @Alex___Oliver, @JCGneuro

    • Contributors All authors contributed to the manuscript. CB, WB, DFK, GL, JJC, and JKC-G were responsible for the conception and design of the work. All authors were involved in drafting the article, critical revision of the article, and final approval of the version to be published. CB is responsible for the overall content as guarantor.

    • 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 DFK received research support from Microvention, Medtronic, Monarch Medical, Balt, Neurogami, Cerenovus, Insera Therapeutics, Brainomix, MiVi, and Stryker; received royalties from Medtronic; and has ownership interest in Superior Medical Experts and Nested Knowledge, Marblehead Medical, Conway Medical, Monarch Biosciences, and Piraeus Medical; serves in the advisory boards of Vesalio and NoNo Inc. WB received research support from MiVi Biosciences; is consultant for Medtronic and Cerenovus; and has ownership interest in Superior Medical Experts. GL is a consultant for Superior Medical Experts and Nested Knowledge. JJC received research support from the National Institute of Health (R01 EY 31301). AAO is a member of the Biomedical Engineering and Physiology Graduate Program and is supported by the Mayo Clinic Graduate School of Biomedical Sciences and American Heart Association (Grant number 23PRE1012781).

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.