Length of Transverse Sinus Covered by Stent Is an Independent Predictor of Improved Visual Outcomes following Venous Sinus Stenting in Patients with Idiopathic Intracranial Hypertension

Introduction: Chronically elevated venous sinus pressures in IIH may potentially cause thinning and weakening of the dural walls covering these sinuses. This can increase their compliance and susceptibility to compression by submaximal or outright elevated CSF pressures or the brain. Following transverse-sigmoid junction (TSJ) stenting, the weak, unstented, distal segment of the TS remains vulnerable to future compression. Consequently, we commonly see distal stent-adjacent restenosis. This could explain suboptimal improvement, persistent or relapsing IIH symptomatology and opening pressures (OP). Increasing the length of TS stented may lead to comprehensive and effective relief from IIH symptoms. Assess if (1) higher percentage length of TS stented (%TSS) and (2) smaller distance between distal stent and torcula (TorcDS) significantly predict headache, visual and papilledema resolution after TSJ stenting.

Methods: This is a retrospective investigation about (1) patient characteristics, (2) venous sinus parameters (and 3) symptom resolution. Symptom improvement was dichotomized into complete, partial or relapsed symptomatology versus persistent or worsening symptoms. Distances were measured from the lateral margin of the posterior sagittal sinus to the TSJ (A) and distal stent (TorcDS) to get the length (A-TorcDS) and percentage length (100*[A-TorcDS]/A = %TSS) of TS stented on 2D anteroposterior venogram. Significant predictors on univariate were considered for multivariate binary logistic regression.

Results: Race, TorcDS, and %TSS significant on univariate did not predict headache improvement on multivariate regression ([Table 1]). Significant univariate predictors for visual outcomes were age, race, papilledema, BMI and OP at presentation, TorcDS, %TSS, pre-stent TS-length, infratentorial pressure gradient (ItPG) and follow-up duration. On backwards multivariate binomial logistic regression, TorcDS and %TS emerged as the sole predictors of visual improvement following TSJ stenting ([Table 2]). Backward multivariate regression shortlisted pre-stent TS length, TorcDS and %TSS for papilledema resolution but were insignificant ([Table 3]).

Conclusion: Maximizing TS stent coverage can potentially confer better resolution of visual disturbances in IIH. This suggests the possibility for endovascular venous reconstruction in IIH, irrespective of the presence of a stenosis.

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Artikel online veröffentlicht:
07. Februar 2025