Purchase this article with an account.
Marc Dinkin, Fabian Laage-Gaupp, Athos Patsalides; A Prospective Trial of Transverse Sinus Stenting for Idiopathic Intracranial Hypertension. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3542.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Stenosis of the transverse-sigmoid sinus junction has been observed in a majority of patients with idiopathic intracranial hypertension (IIH), but its role in the disease remains controversial. Most venous stenting studies to date have been retrospective, only some have included analysis of visual fields, and most have not demonstrated post-procedural opening pressures. We performed a prospective analysis of the effect of venous stenting on clinical symptoms, visual acuity and fields, papilledema, trans-stenotic gradient and intracranial pressure in patients with medically-refractive IIH.
We selected 8 IIH patients who were either medically-refractory/intolerant or presented with fulminant vision loss. Venous angiography was performed and trans-stenotic gradients were measured. Venous stents were placed only in patients with a gradient of 10 mm Hg of more. Stent placement required aspirin and Plavix for one month and aspirin for six months.
Clinical presentation included headache in 100%, pulsatile tinnitus in 87.5 %, and diplopia in 63%. Out of 16 eyes, 16 (100%) demonstrated a visual field defect, 15 (94%) showed papilledema, and 9 (56%) showed loss of visual acuity. Trans-stenotic gradients ranged from 14 to 28 mmHg (mean 19 mmHg). At follow up visits ranging from 2-9 months, 63% reported improvement in headache, 86% in pulsatile tinnitus and 100% in diplopia. Out of 16 eyes with visual field defects, 11 (69%) improved and the remaining 5 (31%) were stable. Out of 15 eyes with papilledema, 7 (47%) showed an improvement in Frisén grade and the remainder were stable. There was improvement in trans-stenotic gradient in 100%. Opening pressure improved in 100%. Complications included one mild retroperitoneal hemorrhage without need for transfusion or surgery.
We present interim data in one of the first prospective FDA-approved clinical trials of transverse sinus stenting for IIH. All patients demonstrated an improvement in trans-stenotic gradient on venography and intracranial pressure as demonstrated by LP. The majority of patients showed an improvement in headache, diplopia and pulsatile tinnitus. The majority of patients showed improvement in visual field defects with stability demonstrated in the remainder. These preliminary results suggest that venous stenting for IIH is efficacious, but larger numbers of patients will be required to confirm this.
This PDF is available to Subscribers Only