Primary balloon angioplasty of venous Sinus stenosis in idiopathic intracranial hypertension

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

doi:10.1177/15910199221089446

Primary balloon angioplasty of venous Sinus stenosis in idiopathic intracranial hypertension

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

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

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 < 0.001). VPS rescue rate was higher in Group A (44 vs. 2%, p = 0.001). There was only one procedural complications; a subdural hematoma in Group A.

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.

Original language	English (US)
Pages (from-to)	358-362
Number of pages	5
Journal	Interventional Neuroradiology
Volume	29
Issue number	4
DOIs	https://doi.org/10.1177/15910199221089446
State	Published - Aug 2023

Keywords

angioplasty
intracranial pressure
stenosis
stent
Cranial Sinuses/surgery
Humans
Male
Treatment Outcome
Constriction, Pathologic/therapy
Female
Stents/adverse effects
Intracranial Hypertension
Retrospective Studies
Angioplasty, Balloon
Pseudotumor Cerebri/diagnostic imaging

ASJC Scopus subject areas

Clinical Neurology
Cardiology and Cardiovascular Medicine
Radiology Nuclear Medicine and imaging

Access to Document

10.1177/15910199221089446

Cite this

Carlos Martinez-Gutierrez, J., Kole, M. J., Lopez-Rivera, V., Inam, M. E., Tang, R., Al-Zubidi, N., Adesina, O. O., Lekka, E., Engstrom, A. C., Sheth, S., Pedroza, C., Day, A. L., & Chen, P. R. (2023). Primary balloon angioplasty of venous Sinus stenosis in idiopathic intracranial hypertension. Interventional Neuroradiology, 29(4), 358-362. https://doi.org/10.1177/15910199221089446

Carlos Martinez-Gutierrez, J, Kole, MJ, Lopez-Rivera, V, Inam, ME, Tang, R , Al-Zubidi, N, Adesina, OO, Lekka, E, Engstrom, AC, Sheth, S, Pedroza, C, Day, AL & Chen, PR 2023, 'Primary balloon angioplasty of venous Sinus stenosis in idiopathic intracranial hypertension', Interventional Neuroradiology, vol. 29, no. 4, pp. 358-362. https://doi.org/10.1177/15910199221089446

@article{2152bdf6df1b45a6a9b5f1282aefd95e,

title = "Primary balloon angioplasty of venous Sinus stenosis in idiopathic intracranial hypertension",

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 < 0.001). VPS rescue rate was higher in Group A (44 vs. 2%, p = 0.001). There was only one procedural complications; a subdural hematoma in Group A.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.",

keywords = "angioplasty, intracranial pressure, stenosis, stent, Cranial Sinuses/surgery, Humans, Male, Treatment Outcome, Constriction, Pathologic/therapy, Female, Stents/adverse effects, Intracranial Hypertension, Retrospective Studies, Angioplasty, Balloon, Pseudotumor Cerebri/diagnostic imaging",

author = "{Carlos Martinez-Gutierrez}, Juan and Kole, {Matthew J.} and Victor Lopez-Rivera and Inam, {Mehmet Enes} and Rosa Tang and Nagham Al-Zubidi and Adesina, {Ore Ofeoluwatomi} and Elvira Lekka and Engstrom, {Allison C.} and Sunil Sheth and Claudia Pedroza and Day, {Arthur L.} and Chen, {Peng Roc}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2022.",

year = "2023",

month = aug,

doi = "10.1177/15910199221089446",

language = "English (US)",

volume = "29",

pages = "358--362",

journal = "Interventional Neuroradiology",

issn = "1591-0199",

publisher = "Centauro SRL",

number = "4",

}

TY - JOUR

T1 - Primary balloon angioplasty of venous Sinus stenosis in idiopathic intracranial hypertension

AU - Carlos Martinez-Gutierrez, Juan

AU - Kole, Matthew J.

AU - Lopez-Rivera, Victor

AU - Inam, Mehmet Enes

AU - Tang, Rosa

AU - Al-Zubidi, Nagham

AU - Adesina, Ore Ofeoluwatomi

AU - Lekka, Elvira

AU - Engstrom, Allison C.

AU - Sheth, Sunil

AU - Pedroza, Claudia

AU - Day, Arthur L.

AU - Chen, Peng Roc

N1 - Publisher Copyright: © The Author(s) 2022.

PY - 2023/8

Y1 - 2023/8

N2 - 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 < 0.001). VPS rescue rate was higher in Group A (44 vs. 2%, p = 0.001). There was only one procedural complications; a subdural hematoma in Group A.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.

AB - 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 < 0.001). VPS rescue rate was higher in Group A (44 vs. 2%, p = 0.001). There was only one procedural complications; a subdural hematoma in Group A.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.

KW - angioplasty

KW - intracranial pressure

KW - stenosis

KW - stent

KW - Cranial Sinuses/surgery

KW - Humans

KW - Male

KW - Treatment Outcome

KW - Constriction, Pathologic/therapy

KW - Female

KW - Stents/adverse effects

KW - Intracranial Hypertension

KW - Retrospective Studies

KW - Angioplasty, Balloon

KW - Pseudotumor Cerebri/diagnostic imaging

UR - http://www.scopus.com/inward/record.url?scp=85127268360&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85127268360&partnerID=8YFLogxK

U2 - 10.1177/15910199221089446

DO - 10.1177/15910199221089446

M3 - Article

C2 - 35323053

AN - SCOPUS:85127268360

SN - 1591-0199

VL - 29

SP - 358

EP - 362

JO - Interventional Neuroradiology

JF - Interventional Neuroradiology

IS - 4

ER -

Primary balloon angioplasty of venous Sinus stenosis in idiopathic intracranial hypertension

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this