Treatment of Cerebral Dural Sinus Stenosis Using Stent Placement: A Systematic Review (P07.273)

Abstract

OBJECTIVE: We performed this systematic review to determine effectiveness and safety of stent placement for dural venous sinus stenosis.

BACKGROUND: Periprocedural complications and long-term outcome following stent placement for treatment of dural venous sinus stenosis have not been systematically evaluated due to infrequent occurrence.

DESIGN/METHODS: We performed a PubMed search to identify studies of sinus stenting using the keywords “cerebral venous thrombosis“ or “pseudotumor cerebri” or “idiopathic intracranial hypertension” or “cerebral arteriovenous malformations” or “dural sinus” in several combinations with the key words “endovascular”, ”stent”, “dural sinus stenting”, “venous sinus stenting”. Manuscripts were identified that met criteria: (1) Dural venous sinus stenosis was confirmed by cerebral angiography or Magnetic Resonance Venography; (2) Stent placement was undertaken either unilaterally or bilaterally (3) Adequate information on the neurological outcome at last contact.

RESULTS: A total of 24 studies, consisting of 117 patients with dural venous sinus stenosis presenting as pseudotumor cerebri (n=97), venous sinus thrombosis (n=3), dural arteriovenous fistula (n=15) or venous hypertension due to arteriovenous malformation (n=2) were found. All the stenotic lesions were located in the transverse sigmoid sinus except 1 lesion was located in the superior sagittal sinus. Successful stent placement was achieved in all 117 patients with improvement in symptoms in 100 (93.5%) patients. Seven subjects (6%, 95% confidence interval [CI] 2.9—11.8) experienced complications which included restenosis (n=2), stent thrombosis (n=2), intracranial hemorrhage (n=2), and transient hemiparesis (n=1). In 93 patients for whom follow-up data was available, favorable long-term outcome was obtained in 97.8% (95% CI 92.5—99.4) patients (n=91) over a mean (±SD) of 12 ± 11.1 months.

CONCLUSIONS: Stent placement for treatment of dural venous sinus stenosis appears to have high technical success and low rates of complications. Persistent improvement in clinical symptoms observed in a high proportion of treated patients support a greater role of stent placement in this patient population.

Disclosure: Dr. Watanabe has nothing to disclose. Dr. Semaan has nothing to disclose. Dr. Majidi has nothing to disclose. Dr. Chaudhry has nothing to disclose. Dr. Adil has nothing to disclose. Dr. Alqadri has nothing to disclose. Dr. ATACH Investigators has nothing to disclose.