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

J Neurointerv Surg. 2017 Sep;9(9):867-874. doi: 10.1136/neurintsurg-2016-012810. Epub 2016 Nov 8.


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.

Keywords: Intervention; Intracranial Pressure; Stenosis; Stent; Vein.

MeSH terms

  • Adolescent
  • Adult
  • Cohort Studies
  • Disease Management
  • Female
  • Follow-Up Studies
  • Hemodynamics* / physiology
  • Humans
  • Male
  • Middle Aged
  • Pseudotumor Cerebri / diagnostic imaging*
  • Pseudotumor Cerebri / surgery*
  • Retrospective Studies
  • Stents* / adverse effects
  • Transverse Sinuses / diagnostic imaging*
  • Transverse Sinuses / surgery*
  • Treatment Failure
  • Young Adult