title: Dural sinus stenting for idiopathic intracranial hypertension: factors associated with hemodynamic failure and management with extended stenting.
abstract: BACKGROUND
  Some patients undergoing dural sinus stenting for idiopathic intracranial hypertension (IIH) develop clinical and hemodynamic failure (recurrence of the pressure gradient) owing to stent-adjacent stenosis.
  
  
  OBJECTIVE
  To characterize factors associated with hemodynamic failure, and to describe outcomes of patients after repeat stenting.
  
  
  METHODS
  We reviewed the initial and follow-up clinical, venographic, and hemodynamic data in 39 patients with IIH treated over 17 years with stenting. Thirty-two had follow-up angiographic and hemodynamic data at 1-99 months (mean 27.6, median 19.5 months). Eight patients were treated with 12 repeat stenting procedures, including extended stenting into the superior sagittal sinus (SSS).
  
  
  RESULTS
  All patients had an initial successful hemodynamic result with the pressure gradient reduced from 10-43 to 0-7 mm Hg. 10/32 patients (31.3%), all women, developed new stenoses in the transverse sinus or posterior SSS above the stent with a recurrent pressure gradient. 7/9 patients with pure extrinsic stenosis of the transverse-sigmoid junction pre-stenting developed new stenoses and hemodynamic failure. All patients with hemodynamic failure who were restented had early and mid-term documented hemodynamic success at 1.7-50 months. They were free from papilledema at 3.8-50 months after the last restenting, and 11.5-99.5 months after initial stent placement (mean 45.3, median 38.5 months).
  
  
  CONCLUSIONS
  Pure extrinsic compression of the transverse-sigmoid junction and female gender were strongly associated with hemodynamic failure. Eight patients with hemodynamic failure who were restented had successful control of papilledema, including 4/4 who had extended stenting into the SSS.
authors.affiliation: Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.|Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Kumpe
authors.affiliation: Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Seinfeld
authors.affiliation: Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.|Department of Interventional Radiology and Vascular Surgery, Suzhou Municipal Hospital, Suzhou, China.
authors.forename: Xianchen
authors.initials: X
authors.lastname: Huang
authors.affiliation: Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.|Department of Interventional Radiology, Nanfang Hospital, Guangzhou, China.
authors.forename: Quelin
authors.initials: Q
authors.lastname: Mei
authors.affiliation: Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Case
authors.affiliation: Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Roark
authors.affiliation: Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.|Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
authors.forename: Prem S
authors.identifier: http://orcid.org/0000-0001-5824-8322
authors.initials: PS
authors.lastname: Subramanian
authors.affiliation: Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
authors.forename: Kimberly E
authors.initials: KE
authors.lastname: Lind
authors.affiliation: Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.|Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
authors.forename: Victoria S
authors.initials: VS
authors.lastname: Pelak
authors.affiliation: Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.|Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Bennett
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011559:Pseudotumor Cerebri / Q000000981:diagnostic imaging* / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D054064:Transverse Sinuses / Q000000981:diagnostic imaging* / Q000601:surgery*; D017211:Treatment Failure; D055815:Young Adult
keywords: Intervention; Intracranial Pressure; Stenosis; Stent; Vein