Association of post-intervention pressure gradient with symptom-free at 6 months in idiopathic intracranial hypertension with venous sinus stenosis treated by stenting

Abstract

Objective This study aimed to identify the key factors that might affect the clinical outcome of patients with idiopathic intracranial hypertension (IIH) and Venous sinus stenting (VSS). Methods We performed an analysis of a prospectively collected database of patients with IIH and VSS who underwent stenting. The trans-stenotic pressure gradient was measured before and after intervention. In additional, patients’ baseline characteristics, procedure details and clinical outcomes at 6-month follow-up (including changes in headache, visual impairment, papilledema, etc.) were recorded. The effects of post-intervention pressure gradient on symptom-free at 6 months were explored using logistic regression analysis, generalized additive model and receiver operator characteristic (ROC) curve. Results Of 101 patients included in this study, the median pressure gradient across stenosis decreased from 19 mmHg before intervention to 2 mmHg after intervention. At 6 months, symptom-free was observed in 58 cases (57.4%). Multivariable logistic analysis and generalized additive model showed that post-intervention pressure gradient (increased by 1 mmHg) was independently and linearly correlated with symptom-free (OR = 0.79, 95% CI = 0.67–0.94). Moreover, the post-intervention pressure gradient revealed moderate discrimination with an area under ROC curve of 0.68 (95% CI = 0.57–0.78). Similar associations were observed for the disappearance of headache and papilledema, but not for the visual recovery. Conclusion The post-intervention pressure gradient may be a valid and reliable predictor of 6-month clinical outcome in patients with IIH and VSS treated by stenting. Nevertheless, external validation with blinded outcome is still needed to confirm its performance before clinical application.

Intracranial venous stenting for idiopathic intracranial hypertension

“…There has only been one similar case report of immediate in-stent occlusion / thrombosis in the literature by Larco et al 16 Satti and Chaudry also reported 14 repeat stenting procedures to treat recurrence of symptoms (10.3%) which is higher than compared with our seven additional procedures (8.4%), again highlighting the technical and clinical success of stenting at our institution. 70% of patients at our institution reported complete resolution of all symptoms compared with a recent study by Wang et al 17 which reported a rate of 57%. In the same meta-analysis by Satti and Chaudry, of the 712 patients that underwent optic nerve sheath fenestration, there was improvement in headaches in 44%, papilloedema in 80% and vision in 59%.…”

“…Satti and Chaudry also reported 14 repeat stenting procedures to treat recurrence of symptoms (10.3%) which is higher than compared with our seven additional procedures (8.4%), again highlighting the technical and clinical success of stenting at our institution. 70% of patients at our institution reported complete resolution of all symptoms compared with a recent study by Wang et al 17 . which reported a rate of 57%.…”