From the Research
Transvenous stenting for pseudotumor cerebri has a relatively favorable safety profile with complication rates ranging from 2-20% overall. The most recent and highest quality study 1 compared the cost of transverse sinus stenting with CSF shunting for the treatment of pseudotumor cerebri, and found that venous stenting costs significantly less per 100 procedures than does CSF shunting. Major complications occur in approximately 2-5% of cases and include venous sinus thrombosis, in-stent stenosis, and stent migration, as reported in earlier studies 2, 3, 4. Minor complications, occurring in 5-15% of patients, include transient headaches, access site hematomas, and allergic reactions to contrast material. Procedure-related mortality is extremely rare at less than 0.5%. Restenosis requiring re-intervention occurs in about 10-15% of patients within the first year. The risk of complications appears to be lower in high-volume centers with experienced operators.
Some key points to consider when evaluating the safety and efficacy of transvenous stenting for pseudotumor cerebri include:
- The importance of proper patient selection, including the presence of venous sinus stenosis and elevated intracranial pressure
- The need for close follow-up with imaging to monitor for restenosis or other delayed complications
- The use of dual antiplatelet therapy to prevent stent thrombosis, typically consisting of aspirin 81-325mg daily and clopidogrel 75mg daily for at least 3-6 months post-procedure, followed by lifelong aspirin therapy, as suggested by earlier studies 2, 5.
Overall, transvenous stenting is a viable treatment option for patients with pseudotumor cerebri, offering a relatively favorable safety profile and potential cost savings compared to CSF shunting procedures.