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Best Practices for Venous Sinus Stenting. Are we over-treating or under-treating patients?

Dr. Patsalides discusses his experience in the application of venous sinus stenting on patients with IIH.

On July 13th Dr. Athos Patsalides was our guest lecturer for our webinar series on IIH. Dr. Patsalides summarized his over 20 years of experience in the application of venous sinus stenting on patients with Idiopathic Intracranial Hypertension (IIH) titled “Best Practices for Venous Sinus Stenting. Are we over-treating or under-treating patients?”

Dr. Patsalides is a Neurointerventionalist at North Shore University and is Chief of NeuroInterventional Surgery at North Shore University Hospital, the flagship hospital of Northwell Health. He has pioneered novel treatments for IIH and pulsatile tinnitus  and is an international expert in diagnosing and treating venous sinus stenosis.

Dr. Y. Pierre Gobin moderated this lecture. He is an interventional neuroradiologist at Weill Cornell Medicine in New York. He is a pioneer in new and effective treatments for cerebral aneurysms and has developed and established minimally invasive surgical approaches to treat acute strokes and eye tumors.

Here is a summary of his lecture:

The results of his first clinical trial on venous sinus stenting (VSS) was published in 2009. It showed that those with IIH who experienced severe vision loss, severe papilledema, and fulminant IIH had significant improvement or complete resolve of these symptoms after the placement of a venous sinus stent. This procedure was found to be effective for normalizing papilledema, eradicating pulsatile tinnitus, making it a great treatment option in those who suffer from IIH.

Other key point from his lecture are:

  • In patients with IIH, after placement of a venous sinus stent, they experienced a 17-point drop of their opening pressure on lumbar puncture. Over 70% of these patients required less acetazolamide/Diamox dosage or did not require it any further.
  • In patients with IIH, even though intracranial pressure (ICP) was normalized through the use of a venous sinus stent, headaches persist. The headaches after treatment are described as migraine-like. Certain risk factors make patients susceptible to persistent headaches.
  • Venous stenting treatment failure is defined as: Ongoing headaches with persistent elevated ICP, no improvement of papilledema, opening pressure on lumbar puncture of 25cm H₂0 or greater after stenting, new stenosis seen on MRV.
  • The risks of VSS are low and include: venous rupture, occlusion the vein of Labbe, infection, restenosis, cerebellar hemorrhage, subdural hematoma, and death.
  • He discussed the shortcomings of current stent options used for the treatment of venous sinus stenosis and future options.
  • Dr. Athos Patsalides and Dr. Marc Dinkin reviewed over 1,600 patients with IIH and their findings were published in the Journal of Neuro-Ophthalmology. To read the full abstract, click here.

If you would like to learn more about venous sinus stenting and its application in the treatment of IIH, please watch the full 1-hour video here.

Thank you for attending our lecture. We look forward to seeing you at our next live webinar in September with Dr. Robert Starke. He is a Neurosurgeon and Neurointerventionalist at the University of Miami and will discuss his experience in treating his patients with IIH. To register for this event, click here.

 

Disclaimer: As of this webinar, no stent has been approved by the FDA for use in the venous sinuses of the brain. Therefore, venous sinus stenting is currently performed with stents used off-label. Neither IIH-Hub nor Serenity Medical, Inc. endorse the off-label usage of stents. The views expressed in this video are those of the speakers alone.

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