Pulsatility attenuation after stent implantation may indicate dural sinus incompetence

The authors report three cases of venous sinus stent implantation for the treatment of idiopathic intracranial hypertension (IIH). Stent implantation resulted in pulsatility attenuation, correction of the pressure gradient and improvement of flow.

They propose that the presence of high venous pulsatility in IIH is likely due to dural sinus incompetence that leads to intracranial pressure (ICP) waveform transmission and may be a marker of an advanced disease state in which chronically raised ICP leads to dural weakening, venous outflow obstruction and a subsequent self-perpetuating cycle. They conclude that the presence of high venous pulsatility may be useful in identifying patients who would benefit from endovascular stent remodeling.

All cases had severe narrowing (> 70 percent) within the transverse sinus and a high pressure gradient across the lesion (> 30 mmHg), which suggests a susceptibility of this region to weakening from chronic increased ICP.

The authors note that IIH remains a poorly understood and therapeutically challenging disease. In patients with IIH and dural sinus narrowing, the role of dural sinus narrowing as either causative, contributory, sustaining or a secondary phenomenon remains controversial.

They say that while enthusiasm has emerged for endovascular therapy with stent reconstruction of dural sinus narrowing, a complete understanding of the hydrodynamic disequilibrium is lacking.