Department of Neurosurgery, University of Texas McGovern Medical School, Houston, Texas, United States.
Department of Neurosurgery, Boston University, Boston, Massachusetts, United States.
Interv Neuroradiol. 2023 Aug;29(4):358-362. doi: 10.1177/15910199221089446. Epub 2022 Mar 24.
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.
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.
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.
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.
静脉窦狭窄（VSS）支架置入术已成为治疗特发性颅内高压（IIH）患者的有效方法。然而，支架置入术存在支架内狭窄/血栓形成的风险，并且长期使用双联抗血小板治疗（DAPT）会累积出血风险。因此，我们研究了原发性球囊血管成形术作为 IIH 患者支架置入术替代方法的潜在安全性和有效性。
对 2012 年至 2021 年期间行血管内介入治疗的 IIH 患者前瞻性维护的单中心登记处进行了查询。纳入标准包括经血管造影证实的 IIH 患者和存在静脉窦狭窄患者，这些患者接受了介入治疗。将患者分为原发性球囊血管成形术（A 组）和原发性支架置入术（S 组），并通过双变量分析比较临床结局。
共纳入 62 例患者，中位年龄为 33 岁[IQR 26-37]，74%为女性。A 组（9/62）和 S 组（53/62）的基线特征相似。S 组在 6 周和 6 个月时视乳头水肿改善程度更高（44%比 93%，p=0.002 和 44%比 92%，p=0.004），所有症状均有相似的改善。S 组术后平均静脉压力梯度变化更大（8 比 3mmHg，p=0.02），6 个月时脑脊液开放压力更低（23 比 36cmH2O，p<0.001）。A 组的 VPS 挽救率更高（44%比 2%，p=0.001）。仅 A 组发生 1 例手术并发症，即硬膜下血肿。
与支架置入术相比，原发性 VSS 球囊血管成形术对 IIH 症状的改善程度较低且短暂。这些结果提示，对于分流不良和支架置入术难治性 IIH 患者，短期血管成形术的作用有限，应谨慎使用。
