Introduction Stenting is increasingly performed for venous sinus stenosis associated with refractory pseudotumor cerebri and pulsatile tinnitus (PT). The Monopoint access system (Route 92 Medical, San Mateo,CA) is a triaxial telescoping system of catheters with simplified points of control outside the body, consisting of: 0.106’ Base Camp guide cather, 0.088 inch ID catheter on a wire (HiPoint 88) and delivery catheter (Tenzing 8). The system may be well suited to venous sinus stenting(VSS).

Case Description A female in her mid-40s presented with pressure headaches, visual obscurations, papilledema with field cut, and PT. MRI revealed bilateral traverse sinus stenoses. Attempted medical therapies (Diamox, weight loss) had failed to improve her condition. DSA showed a dominant right transverse sinus stenosis with a 15 mmHg pressure gradient. VSS was performed. After 9 F femoral venous access, a Basecamp was placed in the right jugular bulb. The right transverse sinus stenosis was crossed, first with a leading 0.014 inch microwire with a ‘J’ shaped tip, followed by Tenzing 8, followed by HiPoint 88, without difficulty. After Tenzing removal, a Zilver 518 8 x 40 mm stent (Cook,Bloomington,IN) was advanced to the target within the HiPoint 88 (figure 1A) and unsheathed by pulling back the HiPoint wire (figure 1B, black arrow). The stent was deployed. No residual stenosis or complications were observed. She was discharged on a 6-months of dual antiplatelets.

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Abstract P046 Figure 1

Results At 8 month clinical follow up, her headaches, vision, papilledema and PT had improved, with wide stent patency on MRI head.

Disclosure of Interest yes Fabio Settecase: consultant and equity interest Route 92 Medical.