114 Angiographic Evaluation and Treatment Outcomes in Suspected Cerebrovascular Causes of Pulsatile Tinnitus

Abstract

INTRODUCTION: Pulsatile tinnitus (PT) can cause significant detriment to quality of life and may herald a life-threatening cerebrovascular etiology. Digital subtraction angiography (DSA) can both provide a definitive diagnostic etiology of PT and offer endovascular treatment, yet the distribution of causes for PT and treatment efficacies remain to be determined. METHODS: Patients suspected to have a cerebrovascular source of PT who were evaluated by endovascular techniques at one large-volume PT center were retrospectively assessed. Baseline clinical features and treatment results by final etiology of PT were compared. RESULTS: 164 patients who underwent endovascular evaluation of PT were included. Mean age was 54.3 ± 14.1 (25–89 years); 111 patients (67.7%) identified as female; and duration of PT was a median 365 days at presentation (range 11–7665 days). Causes of PT were 75.6% cerebrovascular and 24.4% non-vascular. Arteriovenous shunting lesions caused 20.7% of cases; venous etiologies 48.2%; and arterial etiologies 6.7%. Of patients with a shunting lesion treated endovascularly, 96.9% had lasting significant improvement or resolution in PT. Endovascular treatment was also associated with significant improvement in PT due to venous etiologies (73.4% with endovascular treatment vs 17.2% without; p < 1E-5). Arterial PT (18.2%) and non-vascular etiologies (0%) had fewer patients treated endovascularly and less improvement in PT symptoms. CONCLUSIONS: PT with a suspected cerebrovascular cause is most often attributable to venous etiologies. Arteriovenous shunting is a less common etiology of PT, but is the most responsive to treatment, and has the best symptomatic outcomes.