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Correspondence to Dr Ali Alaraj, Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA; alaraj@uic.edu
Introduction
Intracranial venous sinus stenosis (IVSS) has been identified as a common finding in patients with idiopathic intracranial hypertension (IIH).1–6 However, the radiographic finding of dural sinus stenosis does not provide insight on the hemodynamics of the stenosis. Furthermore, the degree of the stenosis does not necessarily correlate with the severity of the disease.3–5 Patients with suspected IIH with evidence of IVSS are usually screened with trans-stenotic venous pressure measurement. Venous stent deployment is performed when the stenosis is hemodynamically significant, with a pressure gradient >8–10 mm Hg.3 5–7
Intracranial venous pressure measurement is an invasive procedure that requires intracranial microcatheterization through direct retrograde venography. In this study, we assessed the intracranial venous hemodynamics with color coded contrast transit time digital subtraction angiography (DSA) post-processing software, two-dimensional (2D) parametric parenchymal blood flow software (Siemens-Healthineers, Forchheim, Germany). We assessed the capacity of the software to identify the presence of hemodynamically significant venous stenosis, and compared the results with our microcatheterization findings performed on the same patient cohort.
Methods
Patient selection
Institutional review board approval was obtained for all patients. We performed a retrospective analysis for patients with hemodynamically significant IVSS who underwent a venous sinus stent procedure at our institution between 2013 and 2018. The control group comprised patients who underwent DSA for other indications, and were matched to our experimental cohort for age, gender, and risk factors. None had venous stenosis on angiography or signs or symptoms of increased intracranial hypertension. All patients who underwent venous stenting in our experimental cohort were found to have an increased trans-stenotic gradient of >8 mm Hg, as measured by manometry during direct retrograde cerebral venography.
Mean venous sinus pressure measurement
All patients in the IVSS group underwent a venous sinus pressure measurement and stenting procedure under general anesthesia. A Prowler Select Plus 0.021 inch microcatheter connected to a manometer was used to measure mean venous pressure both before and after stenting across the superior sagittal sinus, transverse sinus, sigmoid sinus, internal jugular vein, as well as at the proximal and distal regions to the stenotic segment. Intracranial pressure measurement was not performed in the control group.
Image acquisition
All angiograms...