Repeat venous sinus stenting for management of recurrent sinus stenosis related treatment failure of idiopathic intracranial hypertension: A case series

Abstract

BackgroundDural venous sinus stenting (VSS) has been shown to be an effective treatment for idiopathic intracranial hypertension (IIH); however over time, some patients develop treatment failure with formation of a juxta-stent stenosis and a new pressure gradient. Repeat stenting can be performed in these patients to alleviate the stenosis and relieve the elevated pressures preventing complications such as blindness. The efficacy and long-term outcomes of re-stenting is not well described in the literature.MethodsA retrospective review of patients treated at our institution for IIH with VSS over a span of 18 years identified 18 patients who underwent re-stenting for treatment failure. Clinical features, outcomes and venographic data were collated for each patient with a follow-up period ranging from 12 months up to 9 years from their second stent.ResultsThe mean time to repeat stenting was 4 years and 12 months with a range of 1 month up to 16 years and 9 months. Four patients (22.2%) were asymptomatic following second stenting and three patients had recurrent papilledema. Two of these patients (11.1%) had surgical shunting and 1 patient (5.56%) received a third stent. 13 patients (72.2%) had ongoing headaches. There were no major complications in any patient.ConclusionsThis case series demonstrates favourable outcomes for repeat VSS in patients who develop juxta-stent stenosis with a pressure gradient after initial stenting for IIH. A proportion of patients have persistent headache likely due to other mechanisms and a minority may require surgical shunting or further stenting.

Keywords: Idiopathic intracranial hypertension; repeat stenting; treatment failure; venous sinus stenting.

Figure 1.

Right transverse sinus with juxta-stent stenosis before (left) and after re-stenting (right). The juxta-stent stenosis is marked by the arrows.