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. 2023 Sep;33(3):729-737.
doi: 10.1007/s00062-023-01268-0. Epub 2023 Mar 1.

Blood Flow Velocity: a Decision Tool for Stenting Indication in Venous Pulsatile Tinnitus

Alexis Guédon  1   2   3 , Thomas Checkouri  4 , Matteo Fantoni  4 , Vittorio Civelli  4 , Marc-Antoine Labeyrie  4 , Jean-Pierre Saint-Maurice  4 , Fabrice Vallée  5   6   7 , Emmanuel Houdart  4   8
Affiliations

Blood Flow Velocity: a Decision Tool for Stenting Indication in Venous Pulsatile Tinnitus

Alexis Guédon et al. Clin Neuroradiol. 2023 Sep.

Abstract

Background and purpose: Lateral sinus stenosis is the most common cause of venous pulsatile tinnitus (VPT). Stenting is an effective treatment after demonstration of a trans-stenotic pressure gradient; however, pressure measurement has many technical limitations. In 2018, a study showed that a combined approach with intravascular velocity measurement could be effective in identifying most appropriate candidates for stenting. The aim of the present study was to evaluate a new strategy using this biomarker for the indication of stenting even without a significant pressure gradient.

Material and methods: Consecutive patients with disabling VPT were included from 2016 to 2019 and analyzed retrospectively. Intrasinusal pressures were measured and blood flow velocities (with a dual-sensor guidewire) were used for the indication of stenting independent of the pressure gradient. We evaluated the clinical outcome after stenting based on this new biomarker.

Results: A total of 41 patients were treated according to this strategy. At last follow-up (mean = 30.2 months), 32/33 patients (97%) treated by stenting showed complete resolution or a significant decrease in VPT intensity. The use of velocity as the threshold for indicating stenting identified 8 patients (24%) missed by the pressure gradient. Their clinical outcome after stenting was excellent and no complications occurred.

Conclusion: Measurement of sinus blood flow velocity provides a hemodynamic explanation of disease and may be a better tool than pressure gradient for the indication of stenting in VPT.

Keywords: Biomarker; Idiopathic intracranial hypertension; Intravascular velocity; Lateral sinus stenosis; Trans-stenotic pressure gradient.

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