Long Segment Stenting Technique From Torcula To Sigmoid Sinus To Prevent Stent-adjacent Stenosis In Idiopathic Intracranial Hypertension

Introduction: Dural venous sinus stenosis resulting in local venous hypertension and a secondary increase in cerebrospinal fluid buildup and intracranial pressure, is increasingly recognized as an important component of the pathophysiology of idiopathic intracranial hypertension (IIH). Endovascualr stenting has become increasingly used to treat transverse sinus (TS) stenosis and this is often performed over the region of narrowing often using a 40-60 mm long stent; however, stent adjacent stenosis (SAS) continues to burden up to 20% of patients. We aimed to study the safety profile and e"cacy of full-length stenting from sigmoid sinus to torcula in reducing stenotic relapse in TS stenting in patients with IIH using an 80 mm long Cook Zilver stent construct (8 or 10 mm diameter). To understand the pathophysiology of TS stenting complications and propose methods for prevention.

Methods: We reviewed the clinical and angiographic data before and after stent placement for TS stenosis in 44 patients with IIH unresponsive to maximized medical treatment between 2013 and 2023.

Results: Endovascular treatment was successfully performed in all patients (8 cis men, 34 cis females, and 2 trans men, average age 37). Follow-up angiography was performed in 44 patients at a median interval of 4 months. Of the 44 patients, 3 developed SAS (1 in a 40mm stent, 2 in 60 mm stents) and 1 had in-stent stenosis (80 mm stent). We found that of the 26 of the 80 mm stented patients, none experienced SAS, but 17.65% of the shorter stent constructs not spanning torcula to sigmoid sinus stent patients did (p < 0.027).

Conclusion : TS stenting from torcula to sigmoid sinus is a safe and e#ective treatment in selected patients with IIH. Preemptive use of uniformally sized long 80 mm constructs appears to be associated with mitigation of the risk of stent adjacent stenosis.