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Endovascular Treatment of Venous Sinus Stenosis in Idiopathic Intracranial
Hypertension: Complications, Neurological Outcomes, and Radiographic Results
#MMPMID26146651
Starke RM
; Wang T
; Ding D
; Durst CR
; Crowley RW
; Chalouhi N
; Hasan DM
; Dumont AS
; Jabbour P
; Liu KC
ScientificWorldJournal
2015[]; 2015
(?): 140408
PMID26146651
show ga
INTRODUCTION: Idiopathic intracranial hypertension (IIH) may result in a chronic
debilitating disease. Dural venous sinus stenosis with a physiologic venous
pressure gradient has been identified as a potential etiology in a number of IIH
patients. Intracranial venous stenting has emerged as a potential treatment
alternative. METHODS: A systematic review was carried out to identify studies
employing venous stenting for IIH. RESULTS: From 2002 to 2014, 17 studies
comprising 185 patients who underwent 221 stenting procedures were reported. Mean
prestent pressure gradient was 20.1 mmHg (95% CI 19.4-20.7 mmHg) with a mean
poststent gradient of 4.4 mmHg (95% CI 3.5-5.2 mmHg). Complications occurred in
10 patients (5.4%; 95% CI 4.7-5.4%) but were major in only 3 (1.6%). At a mean
clinical follow-up of 22 months, clinical improvement was noted in 130 of 166
patients with headaches (78.3%; 95% CI 75.8-80.8%), 84 of 89 patients with
papilledema (94.4%; 95% CI 92.1-96.6%), and 64 of 74 patients with visual
symptoms (86.5%; 95% CI 83.0-89.9%). In-stent stenosis was noted in six patients
(3.4%; 95% CI 2.5-4.3%) and stent-adjacent stenosis occurred in 19 patients
(11.4%; 95% CI 10.4-12.4), resulting in restenting in 10 patients. CONCLUSION: In
IIH patients with venous sinus stenosis and a physiologic pressure gradient,
venous stenting appears to be a safe and effective therapeutic option. Further
studies are necessary to determine the long-term outcomes and the optimal
management of medically refractory IIH.
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