Department of Neurology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA.
Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA.
J Neurointerv Surg. 2021 Jun;13(6):574-579. doi: 10.1136/neurintsurg-2020-016550. Epub 2020 Sep 7.
Idiopathic intracranial hypertension is a disease of raised intra-cranial pressure of unknown etiology. Lateral cerebral venous sinus stenosis (VSS) has been increasingly reported in these patients, and stenting has emerged as an alternative treatment for medically refractory symptoms. Treatment efficacy on meta-analysis appears promising, but identifying which patients are likely to benefit most, and which are likely to require repeat procedures, is currently unclear.
We retrospectively reviewed a prospectively collected database of 79 patients treated with venous sinus stenting at a single academic center with minimum follow-up of 18 months. We extracted baseline clinical data, as well as manometry at lumbar puncture and during angiography, and used logistic regression to identify parameters that could predict stent failure.
Retreatment rate after successful VSS was 13.9%. Lumbar puncture opening pressure (OP) was shown to significantly predict treatment failure (ß=0.06; OR=1.064 (1.003-1.135); P=0.039). This effect remained significant when age, sex and body mass index were added to the model (ß=0.06; OR=1.066 (1.002-1.140); P=0.043). OP was correlated with venous sinus manometry readings in the superior sagittal and transverse sinus pre-stent placement, as well trans-stenotic gradient (P<0.001).
Higher lumbar puncture OP was associated with an increased risk of stent failure in transverse sinus stenting for idiopathic intracranial hypertension, although the performance of this model as a linear discriminator was poor. Further studies are required to better assess which patients are at greatest risk of treatment failure.
特发性颅内高压是一种病因不明的颅内压升高疾病。在这些患者中，外侧脑静脉窦狭窄（VSS）的报道越来越多，支架置入已成为治疗药物难治性症状的一种替代方法。荟萃分析显示其治疗效果有前景，但目前仍不清楚哪些患者最有可能从中受益，以及哪些患者可能需要重复进行该程序。
我们回顾性分析了一家学术中心的 79 例接受静脉窦支架置入术的患者的前瞻性数据库，这些患者的随访时间至少为 18 个月。我们提取了基线临床数据，以及腰椎穿刺和血管造影时的测压数据，并使用逻辑回归来确定可预测支架失败的参数。
成功的 VSS 后再治疗率为 13.9%。腰椎穿刺开放压（OP）显著预测治疗失败（ß=0.06；OR=1.064（1.003-1.135）；P=0.039）。当将年龄、性别和体重指数添加到模型中时，这种效果仍然显著（ß=0.06；OR=1.066（1.002-1.140）；P=0.043）。OP 与静脉窦测压读数在支架置入前的矢状窦和横窦以及跨窦狭窄梯度呈正相关（P<0.001）。
特发性颅内高压患者经横窦支架置入治疗后，腰椎穿刺 OP 较高与支架失败风险增加相关，尽管该模型作为线性判别器的性能较差。需要进一步研究以更好地评估哪些患者有最大的治疗失败风险。
