Utilizing intravascular ultrasound for optimizing patient selection in venous sinus stenting: A pilot study.

BackgroundVenous sinus stenting (VSS) is an established treatment for idiopathic intracranial hypertension (IIH), and pulsatile tinnitus (PT), but optimal patient selection remains a challenge. Current protocols rely on catheter angiography and manometry-based pressure gradients, which can be operator-dependent and subject to measurement variability. Intravascular ultrasound (IVUS) offers real-time, cross-sectional visualization of venous anatomy, potentially providing more consistent and objective assessments of stenosis severity.MethodsWe conducted a retrospective study of 31 patients undergoing venography with IVUS over an eight-month period for suspected venous sinus stenosis. The point of maximal stenosis severity was measured using both angiography and IVUS, and findings were compared to intravascular pressure gradients. A pressure difference or gradient of ≥8 mmHg in IIH and ≥4 mmHg in PT across the stenosis was considered clinically significant based on prior prospective trial criteria.ResultsPatients included those with IIH (41.9%) or PT (58.1%). Mean maximal stenosis was 51.2% by angiography and 65.2% by IVUS. The agreement between different reviewers measuring angiographic stenosis was low (