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McGrath M, Clarke J, Midtlien JP, Fargen KM, Ali H, Amans MR, Hui F, Brinjikji W, Levitt MR. Safety of intracranial venous stenting in patients with nickel allergy. J Neurointerv Surg 2024:jnis-2024-022094. [PMID: 39084853 DOI: 10.1136/jnis-2024-022094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 07/09/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Nickel hypersensitivity is the most common metal related allergy. Nickel containing alloys are frequently used in endovascular devices. The use of intracranial stents in patients with nickel hypersensitivity appears to be safe, but these small series only evaluated arterial stent placement. This case series aimed to assess the safety of intracranial venous stent placement in patients with documented nickel allergy. METHODS In this retrospective multicenter case series, patients with idiopathic intracranial hypertension and documented nickel allergy underwent treatment with a permanently implanted nickel containing stent in the dural venous sinuses. RESULTS Nine patients with nickel allergy were included. All patients reported clinical improvement in their idiopathic intracranial hypertension symptoms. Of the five patients who had follow-up intracranial venous imaging, all stents remained patent. No patients experienced intraoperative, postoperative, or long term procedure related complications, with follow-up ranging from 1.8 weeks to 49.1 months. CONCLUSION In this limited case series, the use of nickel containing stents in intracranial venous sinuses in patients with nickel allergy did not result in any allergic reaction or adverse outcome.
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Affiliation(s)
- Margaret McGrath
- Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Julian Clarke
- Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Jackson P Midtlien
- Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Kyle M Fargen
- Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Haider Ali
- Radiology and Biomedical Imaging, University of California San Francisco School of Medicine, San Francisco, California, USA
- Neurological Surgery, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Matthew R Amans
- Radiology and Biomedical Imaging, University of California San Francisco School of Medicine, San Francisco, California, USA
- Neurological Surgery, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Ferdinand Hui
- Neurointerventional Surgery, The Queen's Medical Center, Honolulu, Hawaii, USA
| | | | - Michael R Levitt
- Neurological Surgery, University of Washington, Seattle, Washington, USA
- Radiology, Neurology, Mechanical Engineering, Stroke & Applied Neuroscience Center, University of Washington School of Medicine, Seattle, Washington, USA
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Mazur-Hart DJ, Yamamoto EA, Lopez Ramos CG, McIntyre MK, Pang BW, Munger DN, Bagley JH, Dogan A, Bozorgchami H, Nesbit GM, Priest RA, Liu JJ. Venous Sinus Stenting: Safety and Health Care Resource Evaluation for Optimal Recovery in an Evolving Health Care Environment. World Neurosurg 2023; 170:e236-e241. [PMID: 36334713 DOI: 10.1016/j.wneu.2022.10.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Increasing evidence supports the effectiveness of venous sinus stenting (VSS) with favorable outcomes, safety, and expenses compared with shunting for idiopathic intracranial hypertension. Yet, no evidence is available regarding optimal postoperative recovery, which has increasing importance with the burdens on health care imposed by the coronavirus disease 2019 pandemic. We examined adverse events and costs after VSS and propose an optimal recovery pathway to maximize patient safety and reduce stress on health care resources. METHODS A retrospective review was undertaken of elective VSS operations performed from May 2008 to August 2021 at a single institution. Primary data included hospital length of stay, intensive care unit (ICU) length of stay, adverse events, need for ICU interventions, and hospital costs. RESULTS Fifty-three patients (98.1% female) met the inclusion criteria. Of these patients, 51 (96.2%) were discharged on postoperative day (POD) 1 and 2 patients were discharged on POD 2. Both patients discharged on POD 2 remained because of groin hematomas from femoral artery access. There were no major complications or care that required an ICU. Eight patients (15.1%) were lateralized to other ICUs or remained in a postanesthesia care unit because the neurosciences ICU was above capacity. Total estimated cost for initial recovery day in a neurosciences ICU room was $2361 versus $882 for a neurosurgery/neurology ward room. In our cohort, ward convalescence would save an estimated $79,866 for bed placement alone and increase ICU bed availability. CONCLUSIONS Our findings reaffirm the safety of VSS. These patients should recover on a neurosurgery/neurology ward, which would save health care costs and increase ICU bed availability.
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Affiliation(s)
- David J Mazur-Hart
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Erin A Yamamoto
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Christian G Lopez Ramos
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Matthew K McIntyre
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Brandi W Pang
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Daniel N Munger
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Jacob H Bagley
- Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Aclan Dogan
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA; Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Hormozd Bozorgchami
- Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Gary M Nesbit
- Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Ryan A Priest
- Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Jesse J Liu
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA; Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon, USA.
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Zyck S, Malik M, Webb M, Mohammed M, Powers CJ, Birnbaum L, Hawk H, Brinjikji W, Nimjee SM. Technical and clinical success after venous sinus stenting for treatment of idiopathic intracranial hypertension using a novel guide catheter for access: Case series and initial multi-center experience. Interv Neuroradiol 2022:15910199221139545. [PMID: 36397725 DOI: 10.1177/15910199221139545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Venous sinus stenting is a well established alternative to cerebrospinal fluid diversion for the treatment of idiopathic intracranial hypertension (IIH) with associated venous sinus stenosis. During this procedure, distal guide catheter placement within the venous sinuses may be desirable to facilitate stent delivery. We report our initial experience using the TracStar LDP™ (Imperative Care, Campbell, USA, 0.088-inch inner diameter) as the guide catheter for intracranial access during venous sinus stenting. METHODS A multi-institutional retrospective chart review of a prospectively maintained IRB-approved database was performed. Consecutive patients who underwent venous sinus stenting from 1/1/2020-9/6/2021 for IIH were included. Patient characteristics, procedural details, TracStar distal reach, outcomes, and complications were collected and analyzed. RESULTS Fifty-eight patients were included. The mean age was 33.8 years and 93.1% of patients were female. Visual changes prompted evaluation in 86.2% of patients. Stent placement was successful in all patients. The TracStar LDP catheter was advanced to the location of stent placement in 97.9% of cases in which it was attempted. The large 0.088-inch inner diameter lumen enabled compatibility with all desired stent sizes ranging from six to 10 millimeters. Gradient pressure across transverse sinus stenosis dropped from an average of 19.5 mmHg pre-procedure to 1.7 mmHg post-stent placement (p < 0.001). Clinical improvement was achieved in 87.9% (51/58) of patients. There were no catheter-related complications. CONCLUSION The TracStar LDP is a safe and effective access platform for reaching treatment locations in patients who present with idiopathic intracranial hypertension and who are candidates for venous sinus stent placement.
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Affiliation(s)
- Stephanie Zyck
- Department of Neurosurgery, 12306The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Muhammad Malik
- Department of Radiology, 6915Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew Webb
- Department of Neurosurgery, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Marwa Mohammed
- Department of Radiology, 6915Mayo Clinic, Rochester, Minnesota, USA
| | - Ciaran J Powers
- Department of Neurosurgery, 12306The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Lee Birnbaum
- Department of Neurology and Neurosurgery, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Harris Hawk
- Department of Neurosurgery, 2362Erlanger Health System Chattanooga, Chattanooga, Tennessee, USA
| | - Waleed Brinjikji
- Department of Radiology, 6915Mayo Clinic, Rochester, Minnesota, USA
| | - Shahid M Nimjee
- Department of Neurosurgery, 12306The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Aksu Y, Tiryaki Ş. Evaluation of Clinical Findings with MRI Venography in Patients with Idiopatic Intracranial Hypertension. Curr Med Imaging 2022; 18:1378-1383. [PMID: 35578860 DOI: 10.2174/1573405618666220516121352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/01/2022] [Accepted: 02/18/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To evaluate clinical data and Magnetic Resonance Venography (MRV) findings together in patients with idiopathic intracranial hypertension (IIH). MATERIALS AND METHODS In this retrospective study between January 2009 and February 2021, conventional MRI and MRV examinations were performed on 30 patients who were admitted to the neurology service of Erciyes University Medical Faculty with the pre-diagnosis of IIH, cerebrospinal fluid (CSF) pressure was measured in these patients to confirm the diagnosis of IIH. Transverse Sinus Stenosis Ratio (TS SR), Superior Sagittal Sinus (SSS) diameter, Sinus Rectus (SR) diameter, Stenosis Segment Length (SSL) were studied. RESULTS High CSF pressure was detected in 22 of 30 patients with IIH pre-diagnosis. CSF pressure was normal in 8 cases. TS SR was compared in all groups, right TS SR 0.63 ± 0.16, Left TS SR 0.55 ± 0.16 in the patient group with IIH, right TS SR 0.55 ±0.16 in the CSF pressure normal patient group, Right TS SR 0.28 ± 0.07 Left TS SR 0.31 ± 0.07 in the control group Right TS SR It was 0.28 ± 0.09, Sol TS SR was 0.30 ± 0.07. CONCLUSION Before LP, the cranial venous system must be monitored. TS SR and CSF pressure are directly proportional. The stenosis rate is important for IIH rather than SSL.
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Affiliation(s)
- Yusuf Aksu
- Nevşehir State Hospital, Department of Radiology, Nevşehir, Turkey
| | - Şaban Tiryaki
- Kırşehir Ahi Evran University Medical Faculty, Department of Radiology, Kırşehir, Turkey
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Seay MD, Digre KB. Idiopathic Intracranial Hypertension from Benign to Fulminant: Diagnostic and Management Issues. Ann Indian Acad Neurol 2022; 25:S59-S64. [PMID: 36589036 PMCID: PMC9795713 DOI: 10.4103/aian.aian_203_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/01/2022] [Accepted: 03/05/2022] [Indexed: 01/04/2023] Open
Abstract
Idiopathic intracranial hypertension (IIH) primarrily affects obese women of childbearing years and is commonly associated with headaches, pulsatile tinnitus, and vision changes. Though most patients have a "benign" course, it can lead to significant morbidity, including blindness. The treatment approach is based on severity of visual impact and includes weight loss, intracranial pressure lowering medications, and sometimes surgery, such as spinal fluid diversion, optic nerve sheath fenestration, or venous sinus stenting. More studies are needed to determine when surgery is most appropriate and which surgical procedure provides maximal benefit with the least risk.
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Affiliation(s)
- Meagan D. Seay
- Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, UT, United States,Department of Neurology, University of Utah, Salt Lake City, UT, United States,Address for correspondence: Dr. Meagan D. Seay, 65 Mario Capecchi Dr. Salt Lake City, UT, 84132, United States. E-mail:
| | - Kathleen B. Digre
- Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, UT, United States,Department of Neurology, University of Utah, Salt Lake City, UT, United States
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Fargen KM, Kittel C, Amans MR, Brinjikji W, Hui F. A national survey of venous sinus stenting practices for idiopathic intracranial hypertension. J Neurointerv Surg 2022; 15:507-511. [PMID: 35428743 DOI: 10.1136/neurintsurg-2022-018832] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/31/2022] [Indexed: 11/04/2022]
Abstract
BackgroundLittle is currently known about physician opinions and preferences on venous sinus stenting (VSS) for idiopathic intracranial hypertension (IIH), practice patterns, or clinical volumes.MethodsA 19 question online survey was designed and distributed to physician members of the Society of Neurointerventional Surgery (SNIS).ResultsA total of 107 individual survey responses were obtained (14% of SNIS members). The majority of respondents (85%) indicated that they had performed at least one VSS procedure independently during their careers. Mean (SD) and median (range) career case volumes were 20.9 (33.8) and 10.0 (0.0–200.0), respectively. On a 1–10 scale, most respondents reported a high level of interest in treating IIH patients with VSS (median 8), a high level of comfort/expertise in treating IIH patients with VSS (median 9), and that VSS was effective in the long term reduction of symptoms and papilledema in IIH patients (median 8). Fifty-nine per cent of respondents reported increasing VSS volumes compared with previous years. A major complication during a VSS procedure, including two deaths, was reported by 11% of respondents.ConclusionsThis is the first study designed to understand the opinions and practices of neurointerventionists regarding VSS for IIH. Overall physician opinion on VSS was quite positive, supported by increasing procedural volumes reported by most over the past few years. However, only a small percentage of respondents had substantial experience with VSS and major complications were not rare.
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Affiliation(s)
- Kyle M Fargen
- Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Carol Kittel
- Neurological Surgery, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Matthew R Amans
- Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | | | - Ferdinand Hui
- Neuroscience Institute, Queen's Medical Center, University of Hawaii, Honolulu, HI, USA
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Scullen T, Mathkour M, Nerva JD, Dumont AS. Commentary: Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Multi-Center Experience of 154 Consecutive Embolizations. Neurosurgery 2021; 88:E130-E132. [PMID: 33045740 DOI: 10.1093/neuros/nyaa432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tyler Scullen
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, Louisiana
| | - Mansour Mathkour
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, Louisiana
| | - John D Nerva
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, Louisiana
| | - Aaron S Dumont
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, Louisiana
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