Stenting as a treatment for exercise-induced intracranial hypertension from bilateral jugular vein obstruction.
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ABSTRACT:
SUBMITTER: Michel P
PROVIDER: S-EPMC5720618 | biostudies-literature | 2016 Apr
REPOSITORIES: biostudies-literature
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Stenting as a treatment for exercise-induced intracranial hypertension from bilateral jugular vein obstruction.
Michel Patrik P Angelillo-Scherrer Anne A Maeder Philippe P Binaghi Stefano S Meyer Ivo Alexis IA Correia Pamela P
Neurology. Clinical practice 20160401 2
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Project description: Not available
| S-EPMC5336951 | biostudies-literature
Project description:Spontaneous intracranial hypotension, of which brain slump is an extreme expression, is caused by a cerebrospinal fluid leak. The reason the leak develops in the first place, however, is unknown, and some cases can be very difficult to manage. We describe a patient with severe symptoms of spontaneous intracranial hypotension and brain slump documented by magnetic resonance imaging whose clinical syndrome and structural brain anomaly resolved completely after treatment directed exclusively at improving cranial venous outflow. Diagnostics included computed tomography (CT) venography, catheter venography, and jugular venoplasty. CT venography showed narrowing of both internal jugular veins below the skull base. Catheter venography confirmed that these were associated with pressure gradients. Jugular venoplasty performed on two separate occasions as a clinical test gave temporary respite. Lasting remission (2 years of follow-up) was achieved by stenting the dominant internal jugular vein. These findings and this outcome suggest a mechanism for the development of spontaneous intracranial hypotension that would link it to idiopathic intracranial hypertension and have cranial venous outflow obstruction as the underlying cause.
| S-EPMC4520985 | biostudies-other
Project description:Internal jugular vein (IJV) thrombosis is an unusual condition, especially when it develops bilaterally. This is a case of bilateral IJV thrombosis in a 77-year old female who presented to the emergency department with neck and arm swelling after discontinuing apixaban and undergoing an oropharyngeal procedure. The diagnosis of bilateral IJV thrombosis was made with the use of point-of-care ultrasound to evaluate bilateral jugular vein distention and bilateral upper extremity pitting edema found on her physical examination.
| S-EPMC7012569 | biostudies-literature
Project description:To evaluate the results of bilateral endoscopic optic nerve decompression (EOND) with the opening nerve sheath (ONS) technique in patients with idiopathic intracranial hypertension (IIH). Between the years of 2017 and 2019, we retrospectively evaluated nine IIH patients with progressive visual impairment despite medical treatment and who were treated with the EOND and ONS techniques. We also demonstrated our surgical technique recipe on postmortem human heads in a stepwise manner. There were 9 patients (7 females and 2 males) between the ages of 21 and 72 included in this study, and the mean age was 40.8. All patients had an impairment in visual acuity and/or their visual field, with signs of papilledema and/or optic atrophy. The patients were followed up with for 9-48 months. Improvements in visual acuity were observed in 7 out of 9 patients (78%). Visual field defects improved in 5 out of 8 patients (62.5%). Papilledema was resolved in all patients (100%). Headaches improved in all symptomatic patients (100%). No intraoperative or postoperative complications were observed. EOND is a safe and effective surgical procedure in selected patients with IIH. Bilateral wide bony decompression and nerve fenestration can also be an additional benefit for headache relief. Further clinical series and long-term follow-up are needed for more precise results.
| S-EPMC7998922 | biostudies-literature
Project description:BACKGROUND:Massive hemoptysis is a life-threatening condition. Massive hemoptysis caused by pulmonary vein stenosis (PVS) after radiofrequency catheter ablation for atrial fibrillation (AF) is rare. However, bilateral lung hemorrhage following bilateral PVS is extremely rare. CASE PRESENTATION:We herein describe a 62-year-old man with refractory massive hemoptysis after radiofrequency catheter ablation for AF, which was successfully controlled by surgical lobectomy and endovascular bilateral PV stenting. The hemorrhage was derived from the bilateral lungs following PV obstruction and bilateral PVS, which was definitively diagnosed by bronchoscopic examination. The patient had no recurrence of hemoptysis during a follow-up period of 30 months, and the PV stents had not narrowed as shown by computed tomography 30 months after stent placement. CONCLUSIONS:Massive hemoptysis can be caused by bilateral PVS after radiofrequency catheter ablation for AF, and hemorrhage from the bilateral lungs in such patients is extremely rare. Nevertheless, cardiologists, interventional radiologists, and pulmonologists should consider the potential for massive hemoptysis caused by PVS.
| S-EPMC6610941 | biostudies-literature
Project description:BackgroundStenting is a common approach for treating idiopathic intracranial hypertension (IIH) and venous sinus stenosis (VSS). However, studies comparing stenting with balloon angioplasty alone are lacking. This study sought to compare the clinical efficacy of balloon angioplasty and stenting in the treatment of IIH and VSS.MethodsIn this single-center retrospective study, patients were divided into the following two groups: Group S, which comprised patients who underwent stenting with or without balloon angioplasty; and Group B, which comprised patients who underwent balloon angioplasty alone. From January 2018 to June 2023, the medical records of patients with IIH and VSS were evaluated to compare their postsurgical results and subsequent clinical outcomes.ResultsIn total, 122 participants were included in this study; 64 in Group S, and 58 in Group B. There were no differences between the two groups in terms of their initial traits. The efficacy of Group B was similar to that of Group S in terms of headache, sixth nerve palsy, and tinnitus at discharge (all P>0.05); however, the proportion of patients with resolved symptoms was significantly greater in Group S than Group B at the 3-, 6-, and 12-month follow-up (all P<0.05). The patients in Group S had a significantly lower median papilledema Frisén grade (1 vs. 2, P<0.001), a lower mean lumbar puncture opening pressure (210.86 vs. 241.12 mmH2O, P=0.006), and a smaller mean stenosis pressure gradient (1.98 vs. 3.72 mmHg, P=0.004) than those in Group B after surgery. No statistically significant differences were detected in the complication rates between the two groups (7.8% vs. 10.3%, P=0.755).ConclusionsCompared with stenting, balloon angioplasty alone had limited short-term efficacy and unsatisfactory long-term results. Consequently, it is not recommended as a first-line treatment of IIH and VSS but rather as a complementary or adjunctive therapy to stenting.
| S-EPMC11652018 | biostudies-literature
Project description:AimTo characterise the ophthalmic indications for, and ophthalmic efficacy of, transverse sinus stenting in adults with medically refractory idiopathic intracranial hypertension.MethodsA retrospective cohort study was undertaken on a single-author database of 226 successive patients with confirmed idiopathic intracranial hypertension (IIH). A total of 32 patients were identified who received a transverse sinus stent for medically refractory disease. This which was defined as visual threat and/or intolerance of maximal medical therapy. Patients with medically refractory disease proceeded to stenting, if found to have a significant transverse sinus stenosis gradient at catheter venography. Visual threat was quantified via the degree of papilledema on optical coherence tomography of the retinal nerve fibre layer, and via the visual field mean deviation. CSF opening pressure at lumbar puncture and cerebral venous sinus pressure measurements from catheter venography were correlated with the ophthalmic data, noting also intolerance of maximal medical therapy. Complications of stenting were fully assessed.ResultsMedically refractory IIH was found in 18% of the total cohort of IIH patients. 90% of those with medically refractory disease had a significant transverse sinus stenosis pressure gradient, and 80% proceeded to stenting. The intervention eliminated papilledema in 96% of stented patients, and allowed 81% to cease acetazolamide. The need for a further procedure was low at 6%, and the safety profile was favourable.ConclusionsMedically refractory disease in IIH is common (18%), and nearly always associated with a significant transverse sinus stenosis pressure gradient (90%). Endovascular stenting of the stenosis deserves wider uptake as a highly effective, safe, and usually definitive treatment. It safeguards vision by eliminating papilledema (96%), and allows most patients to cease acetazolamide (81%). By analogy with glaucoma, if acetazolamide is the prostaglandin of IIH and CSF diversion the emergency glaucoma filter, stenting is the minimally invasive glaucoma surgery.
| S-EPMC11182310 | biostudies-literature
Project description:BackgroundIn recent years, stenting has been widely used to treat patients with idiopathic intracranial hypertension (IIH) and venous sinus stenosis (VSS); however, research comparing stenting and medical treatment (MT) remains scarce. This study aimed to evaluate the effectiveness of stenting and MT in treating patients with IIH and VSS.MethodsIn this single-center, retrospective, cohort study, the clinical data of patients diagnosed with IIH and VSS at The First Affiliated Hospital of Zhengzhou University from January 2018 to June 2023 were collected for analysis. Based on the treatment approaches, the patients were divided into the following two groups: the stenting group (Group S), and the MT group (Group M). The patients underwent 1:1 propensity score matching (PSM) to compare the improvement in papilledema Frisén grade, lumbar puncture opening pressure (LPOP), and clinical symptoms after treatment.ResultsIn total, 128 participants were included in the study. The participants had an average age of 40.0±11.1 years (range, 18-61 years) and a body mass index (BMI) of 27.5±3.3 kg/m2 (range, 20.0-40.0 kg/m2), and 73.43% were female (68 in Group S and 60 in Group M). Compared with the patients in Group M, those in Group S had a longer median time from onset to treatment (2 vs. 1 month, P=0.026), a higher proportion of papilledema (85.3% vs. 68.3%, P=0.033), a higher median pretreatment stenosis rate (80% vs. 70%, P=0.005), and a larger median pretreatment trans-stenotic pressure gradient (15.5 vs. 11.0 mmHg, P=0.001), and a larger median pretreatment LPOP (391.1 vs. 350.5 mmH2O, P=0.006). Following 1:1 PSM, both groups comprised 28 patients each, and there were no statistically significant differences between the two groups in terms of the covariates (all P>0.05). Compared with the patients in Group M, those in Group S had a lower median papilledema Frisén grade (1 vs. 2, P=0.002) and average LPOP (213.0 vs. 259.8 mmHg, P=0.003) at discharge, and showed more pronounced symptom improvement at the time of discharge (P=0.019), and at 6 months (P=0.011) and 12 months (P<0.001) post-discharge.ConclusionsThe research indicated that stenting was quicker and more effective in alleviating papilledema, LPOP, and corresponding symptoms and signs than MT.
| S-EPMC11744137 | biostudies-literature
Project description:Objective Severe right ventricular outflow tract obstruction in tetralogy of Fallot and variants necessitates the use of transannular patch in a significant proportion of children undergoing repair. We have used a Contegra monocusp together with delamination of native leaflet tissue in order to create a functioning pulmonary valve. Methods In total, 18 (2017-2022) consecutive Contegra monocusp implantations were included. Median age and weight were 3.65 [2.00; 9.43] months and 6.12 [4.30; 8.22] kg, respectively. Nine of 18 patients had undergone palliation. Native pulmonary leaflet tissue was recruited to create a single posterior cusp. Contegra monocusp selection was based on the goal to achieve a neoannulus of Z value ≈ 0. Monocusp sizes implanted were 16 [14; 18] mm. Patch plasty of left pulmonary artery (LPA) (9), right pulmonary artery (RPA) (2), and both LPA-RPA (5) were often performed. Results All patients survived the operation and were discharged home in good health. Median ventilation time and hospital stay were 2 [1; 9] and 12.5 [9; 54] days, respectively. Follow-up duration was 30.68 [3.47; 60.47] months and 100% complete. One patient with well-corrected right ventricular outflow tract died 9.4 months postoperatively, possibly of aspiration. One child with membranous pulmonary atresia needed reoperation (conduit insertion) at 3.5 months of follow-up. Five needed catheter interventions: supravalvar stent (2), LPA stent (3), and RPA stent (1), most of them in the earlier half of the experience. Pulmonary annulus changed from preoperative –3.91 [–5.98; –2.23] to –0.10 [–1.44; 1.92] at discharge; growing proportionally to –0.13 [–3.52; 2.73] at follow-up. Kaplan–Meier freedom from composite dysfunction was 79.25 (95% confidence interval, +13.68%, –31.44%) at 36 months. Conclusions Recruitment of native leaflets, optimal Contegra monocusp, and commissuroplasty provide an easily replicable technique for achieving a competent, proportionally growing neopulmonary valve. Longer follow-up is needed to determine its impact on delaying a pulmonary valve replacement. Video Abstract Graphical Abstract
| S-EPMC10268230 | biostudies-literature
Project description:Background and purposeThe pathophysiology of IIH remains unknown. TS stenoses have been observed in a high proportion of these patients. Stent placement to remove this potential obstruction to venous outflow has been proposed as a treatment option for patients with IIH refractory to medical treatment.Materials and methodsThe clinical presentation, treatment, and outcome of patients with refractory IIH evaluated for venous sinus stent placement at a tertiary care center was retrospectively reviewed.ResultsThirteen female patients with IIH were evaluated for sinovenous stent placement. Moderate sinus stenoses with normal intrasinus pressures were found in 3 patients and therefore stent placement was not performed. Ten patients had elevated intrasinus pressures (pressure gradient across stenosis, 11-50 mm Hg), which decreased following unilateral TS stent placement. Headaches improved or resolved in all stented patients. Papilledema resolved completely or almost completely in 8 patients and significantly improved in 2 patients. One patient developed optic atrophy. There were no major periprocedural complications.ConclusionsIn this small case series, restoring the patency of stenotic venous sinuses with a stent in patients with refractory IIH resulted in symptomatic improvement in all treated patients. The safety and efficacy of this procedure should be evaluated in a randomized controlled study to determine its role within the armamentarium of therapeutic options for patients with IIH.
| S-EPMC7964205 | biostudies-literature