Casper Versus Precise Stent for the Treatment of Patients with Idiopathic Intracranial Hypertension

Nebiyat F Belachew,Eike I Piechowiak,Tomas Dobrocky,Andreas Raabe,Johannes Kaesmacher,Ruben Encinas,Mathias Abegg,Christoph J Schankin,William Almiri,Pasquale Mordasini,Jan Gralla,Severin Baschung

doi:10.1007/s00062-021-01024-2

Nebiyat F Belachew, Eike I Piechowiak + Show 10 more

Open Access

https://doi.org/10.1007/s00062-021-01024-2

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Abstract

PurposeWe hypothesized that due to its specific characteristics, the CasperTM RX carotid stent (CP) might be particularly suitable for venous sinus stenting (VSS) in patients with idiopathic intracranial hypertension (IIH). To test this theory, we compared it to the commonly used Precise Pro RXTM stent (PP).MethodsA total of 15 patients with IIH (median age 28.7 years) were reviewed retrospectively. Technical aspects as well as peri- and postinterventional complication rates were examined in patients treated with CP (n = 10) and the PP (n = 5). Improvements in cerebrospinal fluid opening pressure (CSF OP), transstenotic pressure gradient (TSPG) and clinical symptoms were also assessed.ResultsStent delivery was easier and more successful with the CP than the PP (difficult/failed stent delivery 0.0% versus 57.1%) and consequently achieved with less attempts (≥ 2: 0.0% versus 40.0%). No severe peri- or postinterventional complications or instances of in-stent thrombosis and/or stenosis were observed during follow-up. Improvement of CSF OP and TSPG immediately after VSS as well as at 6‑month follow-up was comparable between the CP and PP group. Both groups showed substantial and similar decreases in intensity and frequency of headache. Almost all patients with other IIH-related symptoms showed either improvement or complete resolution of those symptoms after VSS. All patients who were available for interview (n = 12/15) reported a substantial improvement in quality of life.ConclusionVSS using the CP seems to be safe and effective. The CP may reduce the risk of difficult or failed stent delivery in patients with challenging intracranial venous anatomy.

Highlights

Idiopathic intracranial hypertension (IIH) is a relatively rare disease mainly affecting obese women of childbearing age (12–20 per 100,000 people per year in this group [1])
Venous sinus stenting (VSS) has emerged as a promising and efficient treatment alternative for IIH patients whose condition is not improved by conservative treatment and who demonstrate a functionally relevant venous sinus stenosis [3,4,5,6,7,8,9]; device delivery may be challenging owing to the tortuosity of the transverse and sigmoid sinuses, the high degree of stenosis, the angle of the stenotic segment, small venous channels within the sinus, arachnoid granulations, fibrous trabeculae or the presence of a cortical vein draining into the dural venous sinuses, which are frequently observed in IIH patients [10,11,12,13]
All patients who were available for interview 6 months after VSS (n = 12/15; 80.0%) reported substantial impairment of daily life before VSS, which they attributed to the restraints imposed by IIH

Summary

Introduction

Idiopathic intracranial hypertension (IIH) is a relatively rare disease mainly affecting obese women of childbearing age (12–20 per 100,000 people per year in this group [1]). The increased intracranial pressure observed in patients with IIH may lead to permanent damage of the optic nerve and fulminant vision loss [2]. Venous sinus stenting (VSS) has emerged as a promising and efficient treatment alternative for IIH patients whose condition is not improved by conservative treatment and who demonstrate a functionally relevant venous sinus stenosis [3,4,5,6,7,8,9]; device delivery may be challenging owing to the tortuosity of the transverse and sigmoid sinuses, the high degree of stenosis, the angle of the stenotic segment, small venous channels within the sinus, arachnoid granulations, fibrous trabeculae or the presence of a cortical vein draining into the dural venous sinuses, which are frequently observed in IIH patients [10,11,12,13]. The stent design is aimed to improve coverage, flexibility, conformability and wall apposition of the device, which should lower the risk of periinterventional stroke during carotid artery stenting procedures. We aimed to examine whether these particular stent characteristics provide a technical advantage compared to another commonly used stent devices [18]

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