Yang Hongchao, Huo Xiaochuan, Tong Xu, Wang Zhengyang, Li Xiaoqing, Liu Lian, Wang Shuran, Miao Zhongrong, Mo Dapeng
Department of Neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
J Endovasc Ther. 2025 Apr;32(2):467-474. doi: 10.1177/15266028231175605. Epub 2023 Jun 2.
This study aimed to evaluate the impact of the pressure gradient on papilledema after stenting in patients with idiopathic intracranial hypertension (IIH) patients and venous sinus stenosis (VSS).
In this prospective cohort study, we examined 121 patients with IIH and VSS who underwent stenting. The papilledema Frisen grade at the 1-month follow-up was used as a grouping factor (favorable outcome: 0-1; unfavorable outcome: 2-5). We used multivariable logistic regression modeling to determine independent predictors of favorable outcome. The performance of the prediction model was evaluated using a receiver operating characteristic (ROC) analysis.
A total of 96 patients had papilledema grades 0 to 1, and 25 patients had papilledema grades 2 to 5. Patients with the first group had significantly lower gradient pressures preoperatively (15.2 mmHg vs. 21.4 mmHg, p=0.001) and postoperatively (2 mmHg vs. 3.3 mmHg, p=0.002) relative to those in the second group. Multivariate analysis indicated that preoperative pressure gradient (odds ratio [OR] = 1.119; 95% confidence interval [CI] = 1.034-1.211]) and postoperative pressure gradient (OR = 1.498; 95% CI = 1.147-1.957) were independent predictors of favorable outcome. In the ROC analysis, the cut-off pressure gradient for the highest sensitivity (0.44) and specificity (0.874) was 22.75 mmHg, with a Youden's index of 0.314. Survival analysis demonstrated that patients with a preoperative pressure gradient <22.75 mmHg had more rapid improvement of papilledema than did those with a pressure gradient 22.75 mmHg (meanSD: 2.6390.382 [95% CI: 1.890-3.388] versus meanSD: 3.8820.884 [95% CI: 2.149-5.616]; p=0.004).
A significant reduction in the pressure gradient appears to be strongly correlated with the success of VSS in patients with IIH. A higher preoperative pressure gradient may reduce stenting efficacy in patients with IIH.Clinical ImpactVenous sinus stenting has the potential to yield substantial clinical advantages in individuals diagnosed with idiopathic intracranial hypertension with venous sinus stenosis. Nevertheless, a heightened preoperative pressure gradient could lead to less favorable results. Thus, the early adoption of venous sinus stenting is advised to avert additional irreversible clinical deterioration among idiopathic intracranial hypertension patients with venous sinus stenosis.
本研究旨在评估压力梯度对特发性颅内高压（IIH）合并静脉窦狭窄（VSS）患者支架置入术后视乳头水肿的影响。
在这项前瞻性队列研究中，我们检查了121例接受支架置入术的IIH和VSS患者。将1个月随访时的视乳头水肿Frisen分级用作分组因素（良好结局：0 - 1级；不良结局：2 - 5级）。我们使用多变量逻辑回归模型来确定良好结局的独立预测因素。使用受试者工作特征（ROC）分析评估预测模型的性能。
共有96例患者视乳头水肿分级为0至1级，25例患者视乳头水肿分级为2至5级。相对于第二组患者，第一组患者术前（15.2 mmHg对21.4 mmHg，p = 0.001）和术后（2 mmHg对3.3 mmHg，p = 0.002）的梯度压力显著更低。多因素分析表明，术前压力梯度（比值比[OR] = 1.119；95%置信区间[CI] = 1.034 - 1.211）和术后压力梯度（OR = 1.498；95% CI = 1.147 - 1.957）是良好结局的独立预测因素。在ROC分析中，最高灵敏度（0.44）和特异性（0.874）的临界压力梯度为22.75 mmHg，约登指数为0.314。生存分析表明，术前压力梯度<22.75 mmHg的患者视乳头水肿改善速度比压力梯度≥22.75 mmHg的患者更快（均值±标准差：2.639±0.382 [95% CI：1.890 - 3.388]对均值±标准差：3.882±0.884 [95% CI：2.149 - 5.616]； p = 0.004）。
压力梯度的显著降低似乎与IIH患者VSS治疗的成功密切相关。较高的术前压力梯度可能会降低IIH患者的支架置入疗效。临床影响静脉窦支架置入术对于诊断为特发性颅内高压合并静脉窦狭窄的个体可能产生实质性的临床优势。然而，较高的术前压力梯度可能导致不太理想的结果。因此，建议早期采用静脉窦支架置入术，以避免特发性颅内高压合并静脉窦狭窄患者出现更多不可逆的临床恶化。
