Symptomatic intracranial hypertension can be caused by cerebral venous sinus stenosis (CVSS) and cerebral venous sinus thrombotic (CVST) stenosis, which is usually found in some patients with idiopathic intracranial hypertension (IIH). Recently, at the authors’ center, they utilized intravascular ultrasound (IVUS) as an adjunct to conventional venoplasty or stenting to facilitate diagnosis and accurate stent placement in CVSS.
The authors designed a retrospective review of their prospective database of patients who underwent IVUS-guided venous sinus stenting between April 2016 and February 2017. Clinical, radiological, and ophthalmological information was recorded and analyzed. IVUS was performed in 12 patients with IIH (9 with nonthrombotic CVSS, 3 with secondary stenosis combined with CVST) during venoplasty through venous access. The IVUS catheter was used from a proximal location to the site of stenosis. Post-stenting follow-up, including symptomatic improvement, stent patency, and adjacent-site stenosis, was assessed at 1 year.
Thirteen stenotic cerebral sinuses in 12 patients were corrected using IVUS-guided stenting. No technical or neurological complications were encountered. The IVUS images were excellent for the diagnosis of the stenosis, and intraluminal thrombi were clearly visualized by using IVUS in 3 (25%) of the 12 patients. A giant arachnoid granulation was demonstrated in 1 (8.3%) of the 12 patients. Intravenous compartments or septations (2 of 12, 16.7%) and vessel wall thickening (6 of 12, 50%) were also noted. At 1-year follow-up, 10 of 12 patients were clinically symptom-free in our series.
IVUS is a promising tool with the potential to improve the diagnostic accuracy in IIH, aiding in identification of the types of intracranial venous stenosis, assisting in stent selection, and guiding stent placement. Further study of the utility of IVUS in venous stenting and venous stenosis pathology is warranted.