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  • The Chaperone Technique for Atraumatic Dural Venous Sinus Stent Placement

    Final Number:
    261

    Authors:
    Catherine Miller MD; Jae H. Kim; Ramachandra Tummala MD; Bharathi Jagadeesan MD

    Study Design:
    Other

    Subject Category:
    Ischemic Stroke

    Meeting: AANS/CNS Cerebrovascular Section 2015 Annual Meeting

    Introduction: Idiopathic intracranial hypertension (IIH) is a condition with characteristic signs and symptoms caused by increased intracranial pressure in the absence of an obvious cause. Patients with IIH may have venous hypertension secondary to dural venous sinus stenosis. Venous sinus stent placement has been used as an alternative to cerebrospinal fluid shunting in the treatment of IIH. Endovascular access via the transvenous approach requires navigation of a stent to the transverse-sigmoid sinus junction and can be difficult due to vascular tortuosity.

    Methods: A standard method for accessing the venous sinus system was developed and used in each patient included in this series. We identified 6 patients with the primary diagnosis of IIH who underwent venous sinus stenting from January 2012 to September 2014. Medical records and imaging were then retrospectively reviewed.

    Results: Technical success was obtained in all patients and there were no major periprocedural complications. We obtained internal jugular venous access with a 6 French sheath. Next, we navigated a 0.070” or 0.072” intermediate catheter over a 0.044” Distal Access Catheter over a 0.035” wire (Roadrunner, Cook Medical). This telescoping system allowed navigation past the jugular bulb. The stent (Precise, Cordis) was deployed through the intermediate catheter. All patients had resolution of the venous pressure gradient after stent placement.

    Conclusions: Venous sinus stenting has proven to be an effective treatment method for idiopathic intracranial hypertension. We have developed a technique that is safe, fast, and effective for positioning a large stent delivery system into the dural venous sinuses.

    Patient Care: Knowing all possible treatment options for idiopathic intracranial hypertension allows physicians to offer venous stenting for appropriate patients which may reduce the need for permanent CSF shunting

    Learning Objectives: By the conclusion of this session, participants should be able to : 1) Identify that venous sinus stenting is a treatment option for idiopathic intracranial hypertension, 2) Understand our stenting technique and how to apply it in practice

    References:

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