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Correlation between angiographic stenosis and physiologic venous sinus outflow obstruction in idiopathic intracranial hypertension
  1. James L West1,
  2. Garret P Greenway1,
  3. Rebecca M Garner1,
  4. Carol A Aschenbrenner2,
  5. Jasmeet Singh3,
  6. Stacey Q Wolfe1,
  7. Kyle M Fargen1
  1. 1Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  2. 2Division of Public Health Sciences, Department of Biostatistics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  3. 3Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  1. Correspondence to Dr James L West, Wake Forest University School of Medicine, Winston-Salem, NC 27013, USA; jlwest{at}


Introduction The relationship between degree of angiographic venous sinus stenosis and the trans-stenosis pressure gradient magnitude in idiopathic intracranial hypertension (IIH) is poorly understood. The present study aimed to assess the utility of angiography, venography, and non-invasive imaging (MRV or CTV) for the diagnosis and characterization of clinically significant VSS.

Methods Retrospective analysis of a prospectively collected database was performed to identify patients with medically refractory IIH who were evaluated by angiography and venous manometry for the presence of VSS with associated clinically significant pressure gradient. Angiographic stenosis was measured by two independent raters using novel methodology.

Results Thirty-seven patients met inclusion criteria for the study. In total, 70% of patients had clinically significant pressure gradients and were selected for stenting. The optimal percentage stenosis for detection of a significant pressure gradient was 34% stenosis on venous phase arteriography (sensitivity 0.81 and specificity 0.91) and 31% stenosis on venography (0.92 and 0.73). For every 10% increase in stenosis, an approximate increase in pressure gradient of 3.5 mmHg is seen. MRV/CTV had a calculated sensitivity of 0.42, and a negative predictive value of 22%.

Conclusion The degree of stenosis predictive of a clinically significant pressure gradient (30–35%) in the venous sinuses is considerably lower than the arterial stenosis at which pathologic hemodynamic alterations occur. While highly predictive of a venous pressure gradient when a stenosis is identified, non-invasive imaging does not appear to be a suitable diagnostic evaluation for the purpose of ruling out clinically significant cerebral VSS.

  • vein
  • mri
  • artery
  • stenosis

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  • Contributors JW (conception, design, data collection, data analysis, manuscript preparation), RG (data collection, manuscript preparation), GG (data collection), CA (design, data analysis), JS (conception, design, data collection, manuscript preparation), SW (conception, design, data collection, manuscript preparation), KF (conception, study design, data collection, data analysis, manuscript preparation).

  • 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.

  • Patient consent Not required.

  • Ethics approval Wake Forest Baptist Health IRB.

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

  • Data sharing statement Unpublished data is available upon request from the corresponding author.