Dural sinus stenting for idiopathic intracranial hypertension: factors associated with hemodynamic failure and management with extended stenting

David A. Kumpe*, Joshua Seinfeld, Xianchen Huang, Quelin Mei, David E. Case, Christopher D. Roark, Prem S. Subramanian, Kimberly E. Lind, Victoria S. Pelak, Jeffrey L. Bennett

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

24 Citations (Scopus)

Abstract

Background: Some patients undergoing dural sinus stenting for idiopathic intracranial hypertension (IIH) develop clinical and hemodynamic failure (recurrence of the pressure gradient) owing to stent-adjacent stenosis. 

Objective: To characterize factors associated with hemodynamic failure, and to describe outcomes of patients after repeat stenting. 

Materials and methods: We reviewed the initial and follow-up clinical, venographic, and hemodynamic data in 39 patients with IIH treated over 17 years with stenting. Thirty-two had follow-up angiographic and hemodynamic data at 1-99 months (mean 27.6, median 19.5 months). Eight patients were treated with 12 repeat stenting procedures, including extended stenting into the superior sagittal sinus (SSS). 

Results: All patients had an initial successful hemodynamic result with the pressure gradient reduced from 10-43 to 0-7 mm Hg. 10/32 patients (31.3%), all women, developed new stenoses in the transverse sinus or posterior SSS above the stent with a recurrent pressure gradient. 7/9 patients with pure extrinsic stenosis of the transverse-sigmoid junction pre-stenting developed new stenoses and hemodynamic failure. All patients with hemodynamic failure who were restented had early and mid-term documented hemodynamic success at 1.7-50 months. They were free from papilledema at 3.8-50 months after the last restenting, and 11.5-99.5 months after initial stent placement (mean 45.3, median 38.5 months). 

Conclusions: Pure extrinsic compression of the transverse-sigmoid junction and female gender were strongly associated with hemodynamic failure. Eight patients with hemodynamic failure who were restented had successful control of papilledema, including 4/4 who had extended stenting into the SSS.

Original languageEnglish
Pages (from-to)867-874
Number of pages8
JournalJournal of NeuroInterventional Surgery
Volume9
Issue number9
DOIs
Publication statusPublished - 1 Sep 2017
Externally publishedYes

Keywords

  • Intervention
  • Intracranial Pressure
  • Stenosis
  • Stent
  • Vein

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