Introduction Venous sinus stenting has become increasingly accepted as an acceptable treatment for idiopathic intracranial hypertension (IIH) in selected patients who fail medical treatment and in whom a hemodynamically significant stenosis and pressure gradient can be measured. Technical challenges may include navigating past the jugular bulb or area of stenosis without prolapsing the supporting catheter into the heart and the fact that all carotid stenting systems use a 0.014” wire, which often does not provide adequate support in tortuous venous anatomy.
Methods We review our initial experience using a peripheral vascular stent using brachial or jugular access, which is delivered over a 0.035" wire. In addition, we review the clinical features and angiographic outcomes of these patients.
Results Three patients were available with at least 6 month angiographic follow-up. One patient presented with typical IIH symptoms, one with failure of medical and endovascular treatment for sinus thrombosis, and one with acute severe vision loss, intracranial hypertension and sinus stenosis without obvious thrombus. All patients had documented papilledema and the two acute patients also had bilateral 6th cranial nerve palsies. All patients had venous pressure gradients >20 mmHg across the stenotic segment. All stents were deployed across the target segment from either brachial or cervical venous access with a 6F short sheath and a 0.035" Rosen or glide wire. All stents were 10mm diameter, flexible, open cell stents (LifeStar: Bard PV: Tempe, AZ). One patient required two stents and the remainder required only one. Delayed imaging showed patency of all stents without stenosis (range 6–15 months.) Anti-platelet medications were used in all patients_one with aspirin only, two with aspirin and clopidogrel. All patients had improvement of clinical and ophthalmological symptoms.
Conclusions Venous sinus stenting is a promising treatment for restoration of sinus patency and improvement of clinical symptoms in selected patients. Cervical access and the support of a 0.035” wire makes delivery of the device simpler compared to use of standard carotid stents.
Disclosures A. Carlson: None. A. Delu: None. C. Taylor: None.
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