Symptoms resolved in the majority of patients, but hemorrhage is a concern.
Venous stenting may be an effective option for the treatment of patients with cerebral venous sinus stenosis (CVSS) that is related to cerebral venous sinus thrombosis (CVST) and is refractory to standard medical therapy, according to new research. But caution is warranted due to safety concerns.
The data, from a small series, were published online earlier this month in the Journal of NeuroInterventional Surgery.
CVST accounts for < 1% of strokes and usually affects young women, Ke Li, MD (Xuanwu Hospital, Capital Medical University, Beijing, China), and colleagues explain. “The clinical manifestations may include isolated headache, intracranial hypertension syndrome, focal neurological deficits, and symptoms of diffuse encephalopathy,” they write.
Currently, the first-line treatment approach is anticoagulation with intravenous heparin, but endovascular therapies may be considered in cases of clinical worsening, or for those who do not respond to anticoagulant therapy. The investigators say that venous stenting has demonstrated safety and effectiveness in patients with idiopathic intracranial hypertension and CVSS-related pressure gradient, but that “its efficacy in patients with CVST-related CVSS remains unclear.”
In the study, Li et al retrospectively evaluated the clinical presentation, treatment, and outcome of 17 patients with CVST-related CVSS who underwent venous stenting in the chronic stage of their disease, after failure of medical therapy.
Overall, mean pressure gradient across the stenosis area decreased substantially with stenting, as did mean cerebral spinal fluid (CSF) opening pressure.
Impact of Stenting for CVST-Related Cerebral Venous Sinus Stenosis
|
|
Before |
After |
|
Pressure Gradient Across Cerebral Venous Sinus Stenosis, mm Hg |
11.5 ± 4.2 |
2.1 ± 1.1 |
|
CSF Opening Pressure, cm H2O |
33.1 ± 5.5 |
18.7 ± 1.7 |
In addition, headache resolved in 78% of patients and visual disturbance in 92%.
With respect to complications, there was one case of lethal cerebellar hematoma and another of bilateral occipital epidural hematoma. One patient underwent retreatment with ventriculo-peritoneal shunting due to recurrent headache.
Based on these findings, the authors conclude that venous stenting is effective for improving symptoms. “However, a relatively higher cerebral hemorrhage rate was observed as compared with CVSS for IIH alone,” they write. “The safety and efficacy of this procedure in this subgroup of patients should be evaluated in a larger and more long-term study.”
Source:
Li K, Ren M, Meng R, et al. Efficacy of stenting in patients with cerebral venous sinus thrombosis-related cerebral venous sinus stenosis. J NeuroInterv Surg. 2018;Epub ahead of print.
Disclosures:
Li reports no relevant conflicts of interest.
