Radiology, Mayo Clinic, Rochester, Minnesota, USA
Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
J Neurointerv Surg. 2021 May;13(5):478-482. doi: 10.1136/neurintsurg-2020-016456. Epub 2020 Aug 7.
Cerebral venous sinus stenting is an established treatment for patients with idiopathic intracranial hypertension (IIH), refractory to medical management and with stenotic venous sinus on conventional cerebral venography. Currently, there are no clear guidelines on optimal noninvasive imaging modality for routine post-stenting follow-up. We investigated diagnostic yield of CT venography (CTV) for evaluation of stent patency.
We reviewed our clinical database of patients with a diagnosis of IIH, who underwent stenting of stenotic transverse or transverse/sigmoid sinus junction. Patients who had follow-up CTVs after more than 30 days were included in the final study group. All CTVs were reviewed by two readers for in-stent thrombosis, extrinsic stent compression, juxta-stent stenosis, and new contralateral venous sinus stenosis. Inter-observer agreement and association of stent patency with clinical outcomes (headache and papilledema) were assessed.
In all 36 included patients with 38 cerebral venograms for stenting, follow-up CTVs demonstrated adequate opacifications of the venous sinuses and stents for confident evaluation for in-stent thrombosis, extrinsic stent compression, juxta-stent stenosis, and new contralateral venous sinus stenosis, with inter-observer agreement coefficient of 0.7, 1.0, 0.8, and 1.0 respectively. Association between abnormal CTV and higher rates of persistent headache and lower rates of headache improvement/resolution was statistically significant (P-value of 0.01).
CTV is a reliable noninvasive imaging modality for evaluation of cerebral venous sinuses and stent patency following treatment of idiopathic intracranial hypertension with venous sinus stenting and could be used as a routine follow-up study.
脑静脉窦支架置入术是治疗特发性颅内高压（IIH）的一种成熟方法，对于药物治疗无效且传统脑静脉造影显示静脉窦狭窄的患者，可采用该方法。目前，对于静脉窦支架置入术后的常规随访，尚无明确的最佳无创影像学检查方法的指南。我们研究了 CT 静脉造影（CTV）评估支架通畅性的诊断效能。
我们回顾了经支架置入术治疗狭窄的横窦或横窦/乙状窦交界处的 IIH 患者的临床数据库。将支架置入术后 30 天以上进行 CTV 随访的患者纳入最终的研究组。两名阅片者对所有 CTV 进行评估，以确定支架内血栓形成、支架外压迫、支架内狭窄和新的对侧静脉窦狭窄。评估支架通畅性与临床结局（头痛和视乳头水肿）的相关性，并评估观察者间的一致性。
在 36 例接受支架置入术的患者（共 38 例脑静脉造影）中，所有 CTV 均能充分显影静脉窦和支架，从而能够有信心地评估支架内血栓形成、支架外压迫、支架内狭窄和新的对侧静脉窦狭窄，观察者间一致性系数分别为 0.7、1.0、0.8 和 1.0。CTV 异常与持续性头痛发生率较高和头痛改善/缓解率较低之间存在显著关联（P 值为 0.01）。
CTV 是一种可靠的无创影像学检查方法，可用于评估特发性颅内高压患者静脉窦支架置入术后的静脉窦和支架通畅性，可作为常规随访研究的方法。
