Internal Jugular Vein Stenosis Research Articles

The Promise, Mystery, and Perils of Stenting for Symptomatic Internal Jugular Vein Stenosis: A Case Series.

Cerebral venous outflow disorders (CVDs) secondary to internal jugular vein (IJV) stenosis are becoming an increasingly recognized cause of significant cognitive and functional impairment in patients. There are little published data on IJV stenting for this condition. This study aims to report on procedural success. A single-center retrospective analysis was performed on patients with CVD that underwent IJV stenting procedures. From 2019 to 2023, 29 patients with CVD underwent a total of 33 IJV stenting procedures. Most patients (20; 69%) had an underlying connective tissue disorder diagnosis. The mean age of the included patients was 36.3 years (SD 12.4), 24 were female (82.8%), and all were Caucasian except for 2 patients (27; 93.0%). Twenty-eight procedures (85%) involved isolated IJV stenting under conscious sedation, whereas 5 procedures (15%) involved IJV stenting and concomitant transverse sinus stenting under general anesthesia. Thirteen (39%) patients underwent IJV stenting after open IJV decompression and styloidectomy. Three patients had stents placed for stenosis below the C1 tubercle, one of which was for carotid compression. Periprocedural complications occurred in 11 (33%), including intracardiac stent migration in 1 patient, temporary shoulder pain/weakness in 5 (15%), and persistent and severe shoulder pain/weakness in 2 patients (6%). Approximately 75% of patients demonstrated improvement after stenting although only 12 patients (36%) had durable improvement over a mean follow-up of 4.5 months (range 6 weeks-3.5 years). Our experience, along with early published studies, suggests that there is significant promise to IJV revascularization techniques in these patients; however, stenting carries a high complication rate, and symptom recurrence is common. Most neurointerventionalists should not be performing IJV stenting unless they have experience with these patients and understand technical nuances (stent sizing, anatomy, patient selection), which can maximize benefit and minimize risk.

Commentary: The Promise, Mystery, and Perils of Stenting for Symptomatic Internal Jugular Vein Stenosis: A Case Series.

Commentary: The Promise, Mystery, and Perils of Stenting for Symptomatic Internal Jugular Vein Stenosis: A Case Series.

Remodeling of extracranial veins and venous-arterial imbalance in extrinsic stenosis and hypoplasia of the internal jugular veins

The aim of the study was to compare hemodynamic parameters, the sequence of remodeling of the jugular and extrajugular outflow tracts of cerebral venous circulation in extrinsic stenosis and hypoplasia of the internal jugular vein (IJV). Material and methods. Groups with external compression and IJV stenosis (n = 50), with IJV hypoplasia (n = 27), and after IJV ligation/resection (n = 6) as a model of IJV occlusion with a minimal cerebral venous insufficiency and venous encephalopathy and control group (n = 31) were compared. All patients underwent a neurological examination, ultrasound duplex scanning of the IJV (J2 and at the level of stenosis), common carotid and vertebral artery (V2), 2DToF or 3DToF magnetic resonance venography of the neck veins. The degree of stenosis of the IJV, the crosssectional area and the time average blood flow velocity, the calculated indicator of the venous-arterial balance (VAB) were determined according to the modified formula. Results and discussion. In the group of external compression of the IJV, stenosis averaged 64.52 %. The area of the IJV at the site of stenosis was 6 times, and at the standard place (J2) – 3 times less than the area of the opposite IJV. The hypoplastic IJV throughout its entire length (from J1 to J3) had the same area (0.21 ± 0.12 cm2 ), smooth contours, without local expansions or narrowings. A very low blood flow velocity (10.2 ± 11.67 cm/s) is characteristic for stenosis, in contrast to the normal velocity in the hypoplastic vein and in the control group. The blood flow velocity in the contralateral IJV with external stenosis does not differ from normal, but it is increased with hypoplasia (34.62 ± 12.23 cm/s). With MR venography, it is possible to detect a stenosing factor, symptoms of a filling defect, a decrease or loss of a blood flow signal, and an assessment of the overall picture of remodeling of the venous network of the neck. A decrease in the IJV area on the side of the lesion/anomaly corresponds to negative remodeling, while an expansion of the opposite IJV corresponds to positive remodeling. If the obstruction persists, the homolateral, then the contralateral external jugular vein expands, then the vertebral veins and plexuses, spinal epidural veins, anterior jugular and posterior cervical veins expand too. The magnitude of the IJV on the side of the anomaly/pathology with hypoplasia did not differ from the value with stenosis (9 %), but was slightly less than on the opposite IJV (53.39 ± 13.40 and 67.24 ± 18.02 %, respectively, p < 0.06) and significantly less compared to the control (24.16 ± 8.06 % on the left and 33.15 ± 8.27 % on the right, p < 0.0001), which makes this indicator a good additional criterion for outflow abnormality according to the IJV of one side.

Differential Assessment of Internal Jugular Vein Stenosis in Patients Undergoing CT and MRI with Contrast.

Internal Jugular Vein Stenosis (IJVS) is hypothesized to play a role in the pathogenesis of diverse neurological diseases. We sought to evaluate differences in IJVS assessment between CT and MRI in a retrospective patient cohort. We included consecutive patients who had both MRI of the brain and CT of the head and neck with contrast from 1 June 2021 to 30 June 2022 within the same admission. The degree of IJVS was categorized into five grades (0-IV). A total of 35 patients with a total of 70 internal jugular (IJ) veins were included in our analysis. There was fair intermodality agreement in stenosis grades (κ = 0.220, 95% C.I. = [0.029, 0.410]), though categorical stenosis grades were significantly discordant between imaging modalities, with higher grades more frequent in MRI (χ2 = 27.378, p = 0.002). On CT-based imaging, Grade III or IV stenoses were noted in 17/70 (24.2%) IJs, whereas on MRI-based imaging, Grade III or IV stenoses were found in 40/70 (57.1%) IJs. Among veins with Grade I-IV IJVS, MRI stenosis estimates were significantly higher than CT stenosis estimates (77.0%, 95% C.I. [35.9-55.2%] vs. 45.6%, 95% C.I. [35.9-55.2%], p < 0.001). MRI with contrast overestimates the degree of IJVS compared to CT with contrast. Consideration of this discrepancy should be considered in diagnosis and treatment planning in patients with potential IJVS-related symptoms.

Endovascular treatment of a Right Internal Jugular Vein occlusion in a hemodialysis patient with severe neurological symptomatology

In the last decade, Internal Jugular Vein (IJV) obstructive disease has been gaining increasing attention due to different confounding symptoms that impair patients’ quality of life and cannot be explained by other established causes. The most common clinical symptoms associated with IJV stenosis are tinnitus and sleep disturbances (60.5%), headache (48.8%), visual disturbances (39.5%), hearing disorders (39.5%) and anxiety or depression (37.5%). We report a complex case of a woman with a wide range of severe neurological inexplicable disorders. Using Duplex Ultrasound, an IJV occlusion was successfully diagnosed and the patient was then treated using endovascular techniques. IJVs occlusion and outflow alteration were detected by the means of Duplex Ultrasound (DUS) demonstrating the need of a carefully assessment of neck vessels in patients with drug-resistant neurological symptomatology as headache, tinnitus and sleep disturbances.

Extreme lateral infracondylar approach for internal jugular vein compression syndrome: A case series with preliminary clinical outcomes.

Internal jugular vein (IJV) stenosis is associated with several neurological disorders including idiopathic intracranial hypertension (IIH) and pulsatile tinnitus. In cases of extreme bony compression causing stenosis in the infracondylar region, surgical decompression might be necessary. We aim to examine the safety and efficacy of surgical IJV decompression. We retrospectively reviewed patients who received surgical IJV decompression via the extreme lateral infracondylar (ELI) approach between July 2020 and February 2022. Fourteen patients with IJV stenosis were identified, all with persistent headache and/or tinnitus. Six patients were diagnosed with IIH, three of whom failed previous treatment. Of the eight remaining patients, two failed previous treatment. All underwent surgical IJV decompression via styloidectomy, release of soft tissue, and removal of the C1 transverse process (TP). Follow-up imaging showed significant improvement of IJV stenosis in eleven patients and mild improvement in three. Eight patients had significant improvement in their presenting symptoms, and three had partial improvement. Two patients received IJV stenting after a lack of initial improvement. Two patients experienced cranial nerve paresis, and one developed a superficial wound infection. The ELI approach for IJV decompression appears to be safe for patients who are not ideal endovascular candidates due to bony anatomy. Confirming long-term efficacy in relieving debilitating clinical symptoms requires longer follow-up and a larger patient cohort. Carefully selected patients with symptomatic bony IJV compression for whom there are no effective medical or endovascular options may benefit from surgical IJV decompression.

Long-term safety and efficacy of stenting on correcting internal jugular vein and cerebral venous sinus stenosis.

To compare the long-term safety and efficacy of stenting in correcting cerebral venous sinus stenosis (CVSS) and internal jugular venous stenosis (IJVS). Patients confirmed with CVSS or IJVS by imaging were enrolled in this real-world study from 2014 through 2021. Clinical characteristics and long-term outcomes of these two diseases entities post-stenting were followed up and compared. Three hundred and nineteen patients were enrolled in this study, with a mean age of 48.83 years and a BMI of 25.08 on average. In which, 144 patients underwent stenting, the stenotic segments were corrected and the venous blood flow was restored immediately post-stenting. At 6.15 ± 1.67 days follow-up, significant improvement was observed in headache, tinnitus, insomnia, ICP, and mean pressure gradient in both groups (all p < 0.05). At 30.53 ± 4.41 months follow-up post-stenting, the headache, tinnitus, visual loss, papilledema, and insomnia were attenuated remarkably or even completely disappeared. The Frisen papilledema grade scores declined from 2 (0-4) to 1 (0-3) in IJVS group and from 4 (1-5) to 1 (0-4) in CVSS group compared to the baseline. One hundred and twenty-seven out of the 144 patients (95.5%) maintained sufficient blood flow verified by followed up computed tomographic venography or contrast-enhanced magnetic resonance angiography. Adverse events related to stenting included three cases of intraluminal restenosis and three cases of in-stent thrombosis, no intracranial hemorrhage, venous thromboembolisms, stent-adjacent stenosis, and stent displacement occurred. Using stents to correct IH and related neurological issues has shown to be a safe and effective approach for both IJVS and CVSS.

Chinese expert consensus on the diagnosis and treatment of venous reflux disorders of head and neck

Recently, due to the development of medical imaging technology, diseases related to the venous reflux disorders of head and neck have gradually attracted attention. Cerebral Venous Disease Branch of the Chinese Stroke Association developed "Chinese expert consensus on the diagnosis and treatment of venous reflux disorders of head and neck" after repeated discussions covering recent domestic and international advances. The consensus combines the available medical evidence and clinical practice experience, describes three most common types of venous reflux disorders of head and neck, including cerebral venous thrombosis, venous sinus stenosis and internal jugular vein stenosis, systematically summarizes the etiology and risk factors, clinical manifestations, diagnosis and evaluation, treatment and prognosis, and puts forward 71 recommendations, thereby providing the reference for relevant clinicians and researchers.

The Negative Prognostic Role of Inflammatory Biomarkers in Patients With Chronic Cerebrospinal Venous Insufficiency.

The pathologic consequences of inflammatory responses in chronic cerebrospinal venous insufficiency (CCSVI) remains poorly understood. Hence, this study was aimed to evaluate the peripheral inflammatory biomarkers in patients with intracranial and extracranial CCSVI pathology. In addition, the relationship between inflammatory cytokine profile and CCSVI prognosis was also evaluated. Patients diagnosed with CCSVI between July 2017 and July 2019 were included and subsequently divided into 3 groups based on the location of stenosis. The inflammatory biomarker assay included neutrophil-to-lymphocyte ratios (NLRs), platelet-to-lymphocyte ratios (PLRs), red blood cell distribution widths (RDW), C-reactive protein (CRP) levels, interleukin-6 (IL-6) levels, and neuron-specific enolase levels. Clinical outcomes were assessed using the modified Rankin Scale and Patient Global Impression of Change score. Univariate and multivariate regression analyses were performed to identify significant prognostic factors for poorer outcomes. Finally, we established a nomogram based on the multivariate regression analysis. We enrolled 248 patients in total, including 102 males and 146 females, with an average age of 57.85±12.28 years. Compared with patients with internal jugular vein stenosis, cerebral venous sinus stenosis (CVSS) patients were mostly younger and had been suffering from headaches and severe papilledema. Higher levels of NLR, RDW, and CRP were also observed in the CVSS group. Multivariate analysis indicated that NLR, PLR, and IL-6 were the independent prognostic factors for poor CCSVI outcomes. The clinical presentations and increases in NLR, PLR, IL-6, and CRP levels could be distinctly marked in patients with CVSS-related CCSVI than that in internal jugular vein stenosis-related CCSVI, indicating poor prognostic outcomes in these patients. A proinflammatory state might be associated with CCSVI pathology.

Assessment of Patency of Internal Jugular Vein in Carcinoma Oral Cavity Patients Undergoing Neck Dissection: A Prospective Observational Study

ABSTRACT Background: Neck dissections in carcinoma oral cavity are associated with various postoperative comorbidities. Internal jugular vein (IJV) occlusion and stenosis is a rare serious complication, which leads to serious clinical sequalae. Existing medical literature reports an incidence of this complication varying from 0% to 30%. Lacunae exist regarding any correlation between clinicopathological parameters and treatment options, of such patients, with the incidence of this complication, which might aid in adapting a preventive approach accordingly. Aims and Objectives: a. Primary objective: To study the patency of IJV postoperatively with preoperative status b. Secondary objective: Correlation of postoperative IJV patency with clinicopathological parameters (age, subsite, and pathological nodal status) and treatment options offered (neck dissection, radiotherapy, and reconstruction). Subject and Methods: Patency of IJV was analyzed preoperatively and postoperatively and correlated with various parameters, after neck dissection in 50 carcinoma oral cavity patients. Settings and Design: Prospective observational study at a tertiary care hospital done over 2 years. Statistical Analysis Used: Data were recorded in Excel data sheet and statistically analyzed by using the SPSS Ver 22.0. Results: IJV occlusion was demonstrated in 2 (4%) patients and IJV stenosis in 7 (14%) patients. Postradiotherapy patients had higher incidence of occlusion compared to patients who did not undergo radiotherapy (11.7% vs. 0%; P &lt; 0.05). The incidence of stenosis and occlusion was significantly higher in left side neck dissection (20.6%; P &lt; 0.05). Conclusion: Radiotherapy and left sided neck dissection are statistically significant risk factors for postoperative IJV occlusion in carcinoma oral cavity patients.

Differentiation between anatomical slenderness and acquired stenosis of the internal jugular veins.

Background and PurposesDifferentiating between acquired stenosis (pathologic) and anatomical slenderness (physiologic) of internal jugular vein (IJV) remain ambiguous. Herein, we aimed to compare the similarities and differences between the two entities.MethodsPatients who underwent head and neck computer tomography (CT) and brain magnetic resonance imaging (MRI) were enrolled in this case‐control study from January 2016 through October 2021.Results1487 eligible patients entered final analysis totally. 803 patients had bilateral IJVs imaging without IJV stenosis‐related symptoms and presented in three ways: right IJV slenderness (10.5%, n = 85), left IJV slenderness (48.4%, n = 388), and symmetric IJVs (41.1%, n = 330). In patients with asymmetric IJVs, their bilateral jugular foramina were also asymmetric. All involved asymmetric IJVs presented as slenderness without surrounding abnormal collaterals and credible cloudy‐like white matter hyper‐intensity (WMH). Their cerebral arterial perfusion statuses on brain MR‐PWI maps were normal.In contrast, the major patients with IJV stenosis presented with signs and symptoms such as headaches, head noise, etc. In CE‐MRV maps, local stenosis of the IJV was surrounded by abnormal venous collaterals in contrast to the lack of abnormal venous collaterals for patients with IJV slenderness. And in CTV maps, the caliber of jugular foramina was mismatched with the transverse diameter of IJV. Moreover, in MRI maps of most of these patients, a cloudy‐like WMHs were distributed symmetrically in bilateral periventricular and/or centrum semi vales. These patients also had symmetrical cerebral arterial hypo‐perfusion. Seven patients underwent stenting of the IJV stenosis correction, their WMHs attenuated or disappeared subsequently.ConclusionsImaging features in addition to clinical symptoms can be used to differentiate between physiologic IJV slenderness and pathologic IJV stenosis. Notable imagine‐defining features for IJV stenosis include local stenosis surrounded by abnormal venous collaterals, cloudy‐like WMHs, and mismatch between the transverse diameter of IJV and the caliber of the jugular foramina.

Innominate Vein Stenosis Is Present in Neurogenic Thoracic Outlet Syndrome Patients

It has been established that subclavian and internal jugular vein stenosis is common in patients with neurogenic thoracic outlet syndrome (nTOS). However, a population of nTOS patients with innominate vein stenosis exists that has not been well researched. We compared the demographics and treatment outcomes of nTOS patients with and without innominate vein stenosis.

Surgical Implications of Internal Jugular Stenosis in a Patient Undergoing Resection of a Craniocervical Junction Meningioma

Internal jugular vein (IJV) stenosis is being increasingly associated with certain neurological conditions, including benign intracranial hypertension, cerebrospinal fluid (CSF) disorders, multiple sclerosis and Alzheimer's disease. The role of surgery in IJV stenosis have typically been to manage the associated CSF disorders, or with IJV stents. We describe a case of a patient incidentally found to have bilateral possible IJV stenosis with dilated paraspinal collateral venous channels during pre-operative CT angiogram for a symptomatic craniocervical junction meningioma, and the associated operative considerations.

Anticoagulation in the Treatment of Pulsatile Tinnitus Caused by Internal Jugular Vein Stenosis: A Rare Case Report

Background: Anticoagulation is considered as a first line treatment of pulsatile tinnitus caused by internal jugular vein thrombosis. We present a case of non-thrombotic internal jugular vein occlusion which responded to Apixaban (Eliquis) therapy. Case Presentation: A 54-year-old female with no significant past medical history presented with debilitating pulsatile tinnitus for two months. Her symptoms included inability to sleep, lower appetite, and intense pressure and throbbing in the face and ears. She described it as a ‘whooshing sound’ exacerbated in the supine position. She admitted to occasional episodes of neck throbbing and forceful heart beat over the years and had undergone multiple workups including Echocardiograms and Holter monitoring, with no apparent abnormalities. The recent workup, including coagulation studies, Computed Tomography (CT) scans and Magnetic Resonance Imaging (MRI) of the head and neck, yielded negative findings. However, a CT angiogram revealed an isolated non-thrombotic occlusion of the most proximal aspect of the left Internal Jugular Vein (IJV), with extensive occipital and sub occipital collateral flow. She had been taking antihypertensive and diuretic medications without much effect. She was then prescribed anticoagulation therapy initially with IV enoxaparin (30 milligrams for two weeks) and then oral Apixaban (5 milligrams b.i.d.). Eliquis 5 milligrams bid was continued for 8 months and tapered down to 2.5 milligrams bid for 4 months to completely off in 12 months. Her symptoms improved after eight weeks and were completely gone within a year. Repeat MR angiography showed improved flow in the jugular venous system. Conclusions: A trial of anticoagulation is warranted and can be beneficial in patients with non-thrombotic internal jugular vein occlusion causing pulsatile tinnitus refractory to other treatments.

Styloidogenic-cervical spondylotic internal jugular venous compression, a vascular disease related to several clinical neurological manifestations: diagnosis and treatment-a comprehensive literature review.

Internal jugular vein (IJV) stenosis is associated with several central nervous system disorders such as Ménière or Alzheimer’s disease. The extrinsic compression between the styloid process and the C1 transverse process, is an emerging biomarker related to several clinical manifestations. However, nowadays a limited number of cases are reported, and few information are available about treatment, outcome and complications. Our aim is to collect and identify clinical-radiological characteristics, diagnosis and treatment of the styloidogenic internal jugular venous compression. We performed a comprehensive literature review. Studies reporting patients suffering from extracranial jugular stenosis were searched. For every patient we collected: demography, clinical and radiological characteristics and outcome, type of treatment, complications. Thirteen articles reporting 149 patients were included. Clinical presentation was non-specific. Most frequent symptoms were headache (46.3%), tinnitus (43.6%), insomnia (39.6%). The stenosis was monolateral in 51 patients (45.9%) and bilateral in 60 (54.1%). Anticoagulants were the most common prescribed drug (57.4%). Endovascular treatment was performed in 50 patients (33.6%), surgery in 55 (36.9%), combined in 28 (18.8%). Improvement of general conditions was reported in 58/80 patients (72.5%). Complications were reported in 23% of cases. Jugular stenosis is a complex and often underestimated disease. Conservative medical treatment usually fails while surgical, endovascular or a combined treatment improves general conditions in more than 70% of patients.

Hemodialysis as a Risk Factor for Lower Right Internal Jugular Stenosis in Cardiac Surgery Patients: A Retrospective Single-Center Study.

Lower right internal jugular vein (RIJ) stenosis has been reported as a common cause of RIJ catheterization failure. However, the risk factors for lower RIJ stenosis in patients undergoing cardiac surgery is unclear. We reviewed the electronic medical records of all adult patients who had undergone cardiac operations in a single tertiary university hospital from January 2014 to January 2016. Patients were excluded if they were lack of preoperative contrast-enhanced chest computed tomography (CT) studies. Lower RIJ stenosis was defined as a ratio of cross-sectional area at the smallest level to cross-sectional area at the largest level less than 25%. Multivariable logistic regression analyses were used to investigate the risk factors for lower RIJ stenosis. A sensitivity analysis was also conducted using a cross-sectional area ratio of under 20%. The analysis included 889 patients, and the incidence of lower RIJ stenosis was 3.9%. The multivariable logistic regression analyses revealed that hemodialysis was an independent risk factor for lower RIJ stenosis (OR, 3.54; 95% CI, 1.472–8.514). Sensitivity analysis provided that hemodialysis (OR, 10.842; 95% CI, 3.589–32.75) was a significant predictor of cross-sectional area ratio <20%. Preoperative hemodialysis are significantly associated with an increased risk of lower RIJ stenosis in patients undergoing cardiac surgery. Extra care is needed during central venous catheterization in hemodialysis patients undergoing cardiac surgery.

The antiphospholipid syndrome may induce non-thrombotic internal jugular vein stenosis: two cases report

BackgroundAntiphospholipid syndrome (APS) is associated with a high incidence of thrombotic events, either arterial thrombosis or venous thrombosis. However, APS-related non-thrombotic venous stenosis is rarely reported.Case presentationThis study described two cases of young women with APS-related internal jugular vein stenosis (IJVS) and reviewed current literature on this issue, including clinical features, diagnosis, and treatment.ConclusionsIJVS is a rather rare complication of APS. Two cases were reported for the first time that high titer of antiphospholipid antibodies (aPL) might mediate direct vessel wall damage and further induce venous stenosis despite long-term standardized anticoagulation to prevent thrombus formation. Therefore, dynamic monitoring of autoantibodies and concomitant use of anticoagulants and corticosteroids may be necessary to the management of APS and its complications.

The Morphology and Hemodynamic Characteristics of Patients with Internal Jugular Vein Stenosis

The Morphology and Hemodynamic Characteristics of Patients with Internal Jugular Vein Stenosis

Letter to the Editor Regarding “Styloidectomy and Venous Stenting for Treatment of Styloid-Induced Internal Jugular Vein Stenosis: A Case Report and Literature Review”

Letter to the Editor Regarding “Styloidectomy and Venous Stenting for Treatment of Styloid-Induced Internal Jugular Vein Stenosis: A Case Report and Literature Review”

Clinical characteristics and neuroimaging findings in eagle syndrome induced internal jugular vein stenosis.

Eagle syndrome is a condition that causes pharyngeal pain, facial pain, swallowing difficulties, and symptoms of arterial impingement due to the elongated styloid process. However, few reports were about eagle syndrome with venous compression up to now. This study aimed to identify the clinical profiles of the internal jugular vein stenosis (IJVS) related eagle syndrome comprehensively. A total of 27 patients, who were diagnosed as IJVS induced by styloid process compression were enrolled. The clinical manifestations and imaging features were analyzed. Styloid process compression was presented in all of the 27 IJVS patients, in which, the top three symptoms included insomnia (81.5%), tinnitus (63.0%) and head noises (63.0%). The most vulnerable segment of internal jugular vein (IJV) was J3 segment (96.3%). The average styloid process length in our study was 3.7 cm. Hearing impairment was more common in bilateral IJVS (68.8% vs. 18.2%, P=0.018). One patient reported significant relief of symptoms at 1 year follow-up after underwent styloidectomy combined with stenting. Neurological symptoms of eagle syndrome induced IJVS were various, including either arterial or venous issues. Better understanding of this disease entity may be helpful for clinical diagnosis and treatment.