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Primary balloon angioplasty of venous Sinus stenosis in idiopathic intracranial hypertension

Authors :
Juan Carlos Martinez-Gutierrez
Matthew J Kole
Victor Lopez-Rivera
Mehmet Enes Inam
Rosa Tang
Nagham Al-Zubidi
Ore-Ofeoluwatomi Adesina
Elvira Lekka
Allison C. Engstrom
Sunil Sheth
Claudia Pedroza
Arthur L. Day
Peng Roc Chen
Source :
Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences.
Publication Year :
2022

Abstract

Background Venous sinus stenosis (VSS) stenting has emerged as an effective treatment for patients with Idiopathic Intracranial Hypertension (IIH). However, stenting carries risk of in-stent stenosis/thrombosis and cumulative bleeding risk from long-term dual antiplatelet (DAPT) use. Thus, we investigated the potential safety and efficacy of primary balloon angioplasty as an alternative to stenting in IIH. Methods A prospectively maintained single-center registry of IIH patients undergoing endovascular procedures was queried. Inclusion criteria included patients with confirmed IIH and angiographically demonstrable VSS who underwent interventions from 2012- 2021. Patients were dichotomized into primary balloon angioplasty (Group A) and primary stenting (Group S), comparing clinical outcomes using bivariate analyses. Results 62 patients were included with median age of 33 [IQR 26-37], 74% females. Group A (9/62) and Group S (53/62) had similar baseline characteristics. Papilledema improvement was higher in Group S at 6 weeks and 6 months (44 vs. 93, p = 0.002 and 44 vs. 92%, p = 0.004), with similar improvements across all symptoms. Group S had higher mean post-procedure venous pressure gradient change (8 vs. 3 mmHg, p = 0.02) and a lower CSF opening pressure at 6 months (23 vs. 36 cmH2O, p Conclusions Primary VSS balloon angioplasty provides a marginal and short-lived improvement of IIH symptoms compared to stenting. These findings suggest a cautious and limited role for short-term rescue angioplasty in poor shunting and stenting candidates with refractory IIH.

Details

ISSN :
23852011
Database :
OpenAIRE
Journal :
Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences
Accession number :
edsair.doi.dedup.....4112823fa9c83933fd8736b7e5fd8dfd