You are here

Article Text

Article menu

Download PDFPDF

SNIS 21st annual meeting electronic poster abstracts
E-237 Simplified intracranial access for dural venous sinus stenting: multicenter clinical experience using hipoint 088 and tenzing 8
Free
  1. F Settecase1,
  2. O Goren2,
  3. G Luh3,
  4. T Kass-Hout4,
  5. R Morsi5,
  6. C Martin6,
  7. A Almekkawi6,
  8. N Telischak7,
  9. M Alexander8,
  10. M Abraham9,
  11. S Lingam9,
  12. R Grandhi10,
  13. M Hussain11,
  14. T Jovin12,
  15. P Khandelwal13,
  16. J English1,
  17. M Abdalkader14
  1. 1California Pacific Medical Center, San Francisco, CA
  2. 2Geisinger Health System, Danville, PA
  3. 3Mercy San Juan Medical Center, Carmichael, CA
  4. 4University of Chicago, Chicago, IL
  5. 5Neurology, University of Chicago, Chicago, IL
  6. 6University of Missouri Kansas City, Kansas City, MO
  7. 7Stanford University Medical Center, Stanford, CA
  8. 8Sutter Sacramento Medical Center, Sacramento, CA
  9. 9University of Kansas, Kansas City, KS
  10. 10University of Utah, Salt Lake City, UT
  11. 11Cleveland Clinic, Cleveland, OH
  12. 12Cooper University, Pennington, NJ
  13. 13Rutgers University, Newark, NJ
  14. 14Boston University Medical Center, Boston, MA

Abstract

Background Venous sinus stenting (VSS) is increasingly performed for the management of venous sinus stenosis associated with refractory idiopathic intracranial hypertension (IIH) and pulsatile tinnitus (PT). The technical success of VSS depends upon safely crossing the stenosis, the ability to track rapid-exchange stent delivery systems, and avoiding catheter length incompatibility. The Monopoint access system (MAS) (Route 92 Medical, San Mateo, CA) is a triaxial telescoping system of catheters with simplified points of control outside the body. The system consists of: an 0.106’ Guiding 8F Catheter (Base Camp), a super large bore 0.088’ catheter on a wire (HiPoint 088) and its shelf-reducing delivery catheter (Tenzing 8). The system design may be well suited to VSS. We report the technical feasibility, effectiveness, and safety of this system for VSS.

Methods A retrospective review was conducted of 71 consecutive patients who underwent VSS using the MAS between March 2022 and February 2024, at 14 centers. Patient demographics, clinical, radiological, and technical details were collected.

Results Ninety seven percent (69/71) of patients were female; the median age was 37 years (IQR 33–45). The primary indication for stenting was IIH in 79% (56/71), and 85% (60/71) had PT. Stenting was successful in 100% (71/71). The median procedure duration was 72 (IQR 51–103) minutes, with an average radiation dose 938±102 mGy. A leading microwire was used in 69% (49/71) cases, either to keep the Tenzing out of venous side branches, or to provide additional support and/or centering during stent delivery. All 14 operators reported that MAS performed better than their previous VSS catheter setup, citing ease of crossing the stenosis, improved trackability and support as well as lack of catheter length problems. After the procedure, 74% patients reported improvement in headaches, and 87% reported improved PT. There was one procedural complication, which was not device-related (severe allergic reaction). No intracranial hemorrhage was observed.

Conclusions Use of the MAS for VSS was associated with high technical success rate, short procedure times, low radiation dose, and no complications. Designed for facilitating navigation through tortuous anatomy, the Tenzing 8 facilitated delivery of the HiPoint 088 catheter through the jugular bulb-sigmoid sinus and venous sinus stenoses. Positioning the ‘variable’ length HiPoint across the stenosis provided robust support for stent delivery to the desired target, facilitated stable stent unsheathing and precise stent deployment (figure 1). VSS operators should consider the MAS for improved access, simplicity, speed and support.

Abstract E-237 Figure 1
Abstract E-237 Figure 1

A: Intra-procedural lateral fluoro save showing HiPoint 088 distal tip in transverse sinus beyond the stenosis (solid black arrow), Stent within catheter positioned across stenosis (white arrows) prior to unsheathing/deployment. BaseCamp guide shealth in ipsilateral jugular vein (star). Figure B: Photograph of simplified device setup, taken at same time as Figure A, showing BaseCamp (star), HiPoint 088 proximal wire (black arrow), and Zilver 518 8×40 mm stent (white arrow; Cook Medical,Bloomington, IN)

Disclosures F. Settecase: 1; C; Stryker, Microvention. 2; C; Route 92 Medical, Stryker. 3; C; Stryker. 4; C; Route 92 Medical. O. Goren: 1; C; Penumbra. 2; C; Stryker, Microvention. G. Luh: None. T. Kass-Hout: 2; C; Medical Device Business Services, Stryker. 6; C; Microvention. R. Morsi: None. C. Martin: None. A. Almekkawi: None. N. Telischak: 2; C; Route 92 Medical, Stryker, Microvention. M. Alexander: 2; C; Medtronic, Route 92 Medical. M. Abraham: 2; C; Stryker. S. Lingam: None. R. Grandhi: 1; C; Medtronic, Medical Device Business Services, Inc. 2; C; Medical Device Business Services, Inc. 6; C; Medtronic. M. Hussain: 1; C; E.r. Squibb & Sons, L.l.c., Bayer Healthcare Pharmaceuticals Inc., Medical Device Business Services, Inc., Microvention, Medtronic. 2; C; Medical Device Business Services, Inc., Stryker. T. Jovin: 1; C; Contego, Stryker. 2; C; Medical Device Business Services, Inc. 4; C; Route 92 Medical, Viz.ai, Inc. 6; C; Medtronic, Medical Device Business Services, Inc. P. Khandelwal: 2; C; Stryker. 6; C; Medtronic. J. English: 2; C; Route 92 Medical, Stryker. 3; C; Canon Medical Systems, Route 92 Medical. 4; C; Route 92 Medical. M. Abdalkader: None.

https://doi.org/10.1136/jnis-2024-SNIS.342

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.