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Original research
Mid-term assessment of transverse sinus stent patency in 104 patients treated for intracranial hypertension secondary to dural sinus stenosis
  1. Amgad El Mekabaty1,
  2. Monica Smith Pearl1,2,
  3. Abhay Moghekar3,
  4. Philippe Gailloud1
  1. 1Division of Interventional Neuroradiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
  2. 2Department of Radiology, Children's National Medical Center, Washington DC, District of Columbia, USA
  3. 3Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland, USA
  1. Correspondence to Dr Philippe Gailloud, Division of Interventional Neuroradiology, Johns Hopkins Hospital, Baltimore, MD 21287, USA; phg{at}jhmi.edu

Abstract

Background Transverse sinus (TS) stenting is a valid treatment alternative for patients with intracranial hypertension caused by underlying bilateral TS stenoses. Its mid-term patency has, however, not been well documented.

Objective To assess the 6-month patency of TS stenting using subtracted CT venography (CTV).

Methods A retrospective analysis of a prospectively collected database of patients undergoing TS stenting was performed. The cohort was a single-center, single-operator series of 125 consecutive patients treated between 2008 and 2018. Mid-term follow-up 320-row detector CTV was available for review in 104 patients.

Results Follow-up CTV was obtained on average 6 months after stenting. Stents in all patients (100%) were patent. Subtracted reconstructions showed no intraluminal thrombus or neointimal hyperplasia. Native reconstructions confirmed the structural integrity of the stents. De novo stenosis proximal to the stent was noted in 10 cases (10%). A total of 10 patients (10%) received additional treatment due to recurrent symptoms. In univariate analysis, both high body mass index and stent size (>6 mm) were associated with development of de novo stenoses: OR 1.12 (95% CI 1.01 to 1.25, p=0.037) and OR 5.63 (95% CI 1.16 to 27.22, p=0.032), respectively. In multivariate analysis, only stent size (>6 mm) remained significant: OR 7.19 (95% CI 1.03 to 50.01, p=0.046).

Conclusion TS stenting is an effective treatment for intracranial hypertension secondary to dural sinus stenosis in an appropriately selected patient population. A 320-row dynamic CTV is a high-quality non-invasive imaging method that can assess both the physical integrity of the stent and its patency. At mid-term follow-up, all imaged stents were patent. The occurrence of de novo stenoses proximal to the stent (10%) correlated with stent size (>6 mm).

  • stenosis
  • CT angiography
  • intracranial pressure
  • stent
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Footnotes

  • Contributors All authors participated in the design, conceptual design and approved the final version of the draft.

  • Funding This work was supported by Swiss National Science Foundation (SNSF), grant number P2SKP3-164949, in the form of as a mobility career stipend for the first author (AEM).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Institutional Review Board approval (no: NA_00026773) was obtained both for data collection and result publication.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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