Venous sinus outflow geometry as a predictor of transverse sinus stenting complexity.

The treatment of symptomatic transverse sinus (TS) stenosis by neurointerventional techniques is becoming more popular. Having the ability to predict procedural success and complexity holds a potential to increase success and reduce complication rates. Here we tried to assess procedural complexity by dural venous geometry parameters. We reviewed TS stenting or stent assisted coiling of all the patients treated for symptomatic TS stenosis during august 2021 and October 2023. The dataset was divided into two groups based on the shallowest angle (the angle of lowest energy, LEa) between the nadirs of the 3 turns – internal jugular vein, jugular foramen and proximal curve of the sigmoid sinus, and further comparison between these groups characteristics and procedural metrics was performed. Out of 20 procedures, six had a positive LEa and 14 a negative one. Negative LEa was associated with significantly longer interventional time (18.9 +/- 6.4 vs. 7.3 +/- 1.4 minutes; p = 0.004) and a higher jugular bulb (14.0 +/- 3.1 vs. 9.5 +/- 2.5 mm; p = 0.04). Regression analysis further showed that both LEa and TS stenosis independently predicted interventional time (-0.2 +/- 0.03 minutes per degree, p = 0.00003; and +29.1 +/- 8.8 minutes for a theoretical 100% stenosis, p = 0.005, respectively). Negative LEa is a novel strong geometric predictor of longer procedural time, with TS stenosis severity contributing additional delay. Incorporating these factors into planning may improve efficiency, outcomes, and safety.