Recommendations for the selection and treatment of patients with idiopathic intracranial hypertension for venous sinus stenting

Kyle M. Fargen, Kenneth Liu, Rebecca M. Garner, Garret P. Greeneway, Stacey Q. Wolfe, R. Webster Crowley

Research output: Contribution to journalReview article

6 Citations (Scopus)

Abstract

Introduction Although venous sinus stenting (VSS) has emerged as a promising treatment option for patients with idiopathic intracranial hypertension (IIH) and associated venous sinus stenosis, there is considerable ambiguity regarding patient selection criteria, treatment protocols, and management strategies. Methods An extensive literature review was performed to identify all reports of VSS in patients with IIH using PubMed. Recommendations for the selection and treatment of patients with IIH with VSS are outlined as determined based on author opinion from supporting studies. Due to the lack of randomized trials and few published prospective studies, standard grading scales for recommendations and level of evidence are not fully applicable and therefore a revised grading scale has been provided for recommendations. Results The literature review identified a total of eight systematic reviews or meta-analyses and 29 published patient series on VSS. Recommendations for patient selection for diagnostic catheter angiography, angiography procedural considerations, stenting procedural considerations, and retreatment are provided based on the literature. Recommendations that were considered strong included: performance of venous sinus manometry to assess candidacy for treatment prior to stenting; administration of antiplatelet agents prior to stenting and for a follow-up period of at least 3-6 months; performance of post-stenting manometry to confirm resolution of pressure gradient; and performance of repeat angiography and manometry on patients with recurrence of symptoms after resolution with stenting to evaluate for recurrent stenosis. Conclusion V SS for patients with IIH with venous sinus stenosis is now an established and effective treatment option. These recommendations have been provided, based on a summative review of the available published literature, to assist in standardizing care for patients with IIH undergoing VSS.

Original languageEnglish (US)
Pages (from-to)1203-1208
Number of pages6
JournalJournal of NeuroInterventional Surgery
Volume10
Issue number12
DOIs
StatePublished - Dec 1 2018

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Pseudotumor Cerebri
Patient Selection
Manometry
Angiography
Pathologic Constriction
Therapeutics
Retreatment
Platelet Aggregation Inhibitors
Clinical Protocols
PubMed
Meta-Analysis
Patient Care
Catheters
Prospective Studies
Pressure
Recurrence

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Fargen, Kyle M. ; Liu, Kenneth ; Garner, Rebecca M. ; Greeneway, Garret P. ; Wolfe, Stacey Q. ; Crowley, R. Webster. / Recommendations for the selection and treatment of patients with idiopathic intracranial hypertension for venous sinus stenting. In: Journal of NeuroInterventional Surgery. 2018 ; Vol. 10, No. 12. pp. 1203-1208.
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abstract = "Introduction Although venous sinus stenting (VSS) has emerged as a promising treatment option for patients with idiopathic intracranial hypertension (IIH) and associated venous sinus stenosis, there is considerable ambiguity regarding patient selection criteria, treatment protocols, and management strategies. Methods An extensive literature review was performed to identify all reports of VSS in patients with IIH using PubMed. Recommendations for the selection and treatment of patients with IIH with VSS are outlined as determined based on author opinion from supporting studies. Due to the lack of randomized trials and few published prospective studies, standard grading scales for recommendations and level of evidence are not fully applicable and therefore a revised grading scale has been provided for recommendations. Results The literature review identified a total of eight systematic reviews or meta-analyses and 29 published patient series on VSS. Recommendations for patient selection for diagnostic catheter angiography, angiography procedural considerations, stenting procedural considerations, and retreatment are provided based on the literature. Recommendations that were considered strong included: performance of venous sinus manometry to assess candidacy for treatment prior to stenting; administration of antiplatelet agents prior to stenting and for a follow-up period of at least 3-6 months; performance of post-stenting manometry to confirm resolution of pressure gradient; and performance of repeat angiography and manometry on patients with recurrence of symptoms after resolution with stenting to evaluate for recurrent stenosis. Conclusion V SS for patients with IIH with venous sinus stenosis is now an established and effective treatment option. These recommendations have been provided, based on a summative review of the available published literature, to assist in standardizing care for patients with IIH undergoing VSS.",
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Recommendations for the selection and treatment of patients with idiopathic intracranial hypertension for venous sinus stenting. / Fargen, Kyle M.; Liu, Kenneth; Garner, Rebecca M.; Greeneway, Garret P.; Wolfe, Stacey Q.; Crowley, R. Webster.

In: Journal of NeuroInterventional Surgery, Vol. 10, No. 12, 01.12.2018, p. 1203-1208.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Recommendations for the selection and treatment of patients with idiopathic intracranial hypertension for venous sinus stenting

AU - Fargen, Kyle M.

AU - Liu, Kenneth

AU - Garner, Rebecca M.

AU - Greeneway, Garret P.

AU - Wolfe, Stacey Q.

AU - Crowley, R. Webster

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Introduction Although venous sinus stenting (VSS) has emerged as a promising treatment option for patients with idiopathic intracranial hypertension (IIH) and associated venous sinus stenosis, there is considerable ambiguity regarding patient selection criteria, treatment protocols, and management strategies. Methods An extensive literature review was performed to identify all reports of VSS in patients with IIH using PubMed. Recommendations for the selection and treatment of patients with IIH with VSS are outlined as determined based on author opinion from supporting studies. Due to the lack of randomized trials and few published prospective studies, standard grading scales for recommendations and level of evidence are not fully applicable and therefore a revised grading scale has been provided for recommendations. Results The literature review identified a total of eight systematic reviews or meta-analyses and 29 published patient series on VSS. Recommendations for patient selection for diagnostic catheter angiography, angiography procedural considerations, stenting procedural considerations, and retreatment are provided based on the literature. Recommendations that were considered strong included: performance of venous sinus manometry to assess candidacy for treatment prior to stenting; administration of antiplatelet agents prior to stenting and for a follow-up period of at least 3-6 months; performance of post-stenting manometry to confirm resolution of pressure gradient; and performance of repeat angiography and manometry on patients with recurrence of symptoms after resolution with stenting to evaluate for recurrent stenosis. Conclusion V SS for patients with IIH with venous sinus stenosis is now an established and effective treatment option. These recommendations have been provided, based on a summative review of the available published literature, to assist in standardizing care for patients with IIH undergoing VSS.

AB - Introduction Although venous sinus stenting (VSS) has emerged as a promising treatment option for patients with idiopathic intracranial hypertension (IIH) and associated venous sinus stenosis, there is considerable ambiguity regarding patient selection criteria, treatment protocols, and management strategies. Methods An extensive literature review was performed to identify all reports of VSS in patients with IIH using PubMed. Recommendations for the selection and treatment of patients with IIH with VSS are outlined as determined based on author opinion from supporting studies. Due to the lack of randomized trials and few published prospective studies, standard grading scales for recommendations and level of evidence are not fully applicable and therefore a revised grading scale has been provided for recommendations. Results The literature review identified a total of eight systematic reviews or meta-analyses and 29 published patient series on VSS. Recommendations for patient selection for diagnostic catheter angiography, angiography procedural considerations, stenting procedural considerations, and retreatment are provided based on the literature. Recommendations that were considered strong included: performance of venous sinus manometry to assess candidacy for treatment prior to stenting; administration of antiplatelet agents prior to stenting and for a follow-up period of at least 3-6 months; performance of post-stenting manometry to confirm resolution of pressure gradient; and performance of repeat angiography and manometry on patients with recurrence of symptoms after resolution with stenting to evaluate for recurrent stenosis. Conclusion V SS for patients with IIH with venous sinus stenosis is now an established and effective treatment option. These recommendations have been provided, based on a summative review of the available published literature, to assist in standardizing care for patients with IIH undergoing VSS.

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U2 - 10.1136/neurintsurg-2018-014042

DO - 10.1136/neurintsurg-2018-014042

M3 - Review article

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SP - 1203

EP - 1208

JO - Journal of NeuroInterventional Surgery

JF - Journal of NeuroInterventional Surgery

SN - 1759-8478

IS - 12

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