|Paper title||Role of 320-row subtracted dynamic volume CT venography in evaluating transverse sinus stent patency in patients with idiopathic intracranial hypertension|
|Form of presentation||Poster|
Dural sinus stenting has emerged as a new treatment modality for patients with idiopathic intracranial hypertension (IIH) for underlying bilateral transverse sinus (TS) stenosis. Stent patency however is not well documented. In this study aim to evaluate the anatomic result of TS stenting at 6 months using 320-row subtracted dynamic volume CT venography (CTV).
Materials and Methods:
A retrospective analysis of a prospectively collected database of patients undergoing TS stenting was performed. In the time period between January 2008 and January 2017, 77 patients received TS stenting in our institution. Long-term Follow-up 320-row CTV was available for 63 patients. All patients had exhausted conventional medical management and had progressive visual impairment. CTV was obtained with a 320-row detector CT scanner (Aquilion One CT and Vision CT, Toshiba, Japan).
At the 6-month follow-up, all 63 patients had fully patent stents (100%). There was no evidence of intraluminal abnormalities, such as clot formation or neo-intimal hyperplasia, while native MIP reconstructions documented the absence of structural stent anomalies, such as kinking or displacement. De novo stenosis was noted proximal to the stent in 9 patients (7 juxta-stent TS stenosis, 1 straight sinus stenosis and 1 juxta-stent TS and straight sinus stenosis). The mechanism behind this phenomenon remains unclear, and could be linked to sinus deformation secondary to stent oversizing early in the series. In the univariate analysis both BMI and large stent size (>6mm) were associated with the development of de novo dural sinus stenosis; OR 1.12 (95% CI: 1.01-1.25, p=0.037) and OR 5.63 (95% CI: 1.16-27.22, p=0.032), respectively. In the multivariate analysis only large stent size (>6 mm) was significant; OR 7.19 (95% CI: 1.03-50.01, p=0.046).
TS stenting is an effective and clinically durable modality for the treatment of IIH in an appropriately selected patient population. At the 6-month follow-up evaluation, all the imaged stents were patent. In our cohort, large stent size (>6 mm) was independently correlated with the development of de novo dural sinus stenosis.