Blood Flow Velocity: a Decision Tool for Stenting Indication in Venous Pulsatile Tinnitus

Clin Neuroradiol. 2023 Sep;33(3):729-737. doi: 10.1007/s00062-023-01268-0. Epub 2023 Mar 1.

Abstract

Background and purpose: Lateral sinus stenosis is the most common cause of venous pulsatile tinnitus (VPT). Stenting is an effective treatment after demonstration of a trans-stenotic pressure gradient; however, pressure measurement has many technical limitations. In 2018, a study showed that a combined approach with intravascular velocity measurement could be effective in identifying most appropriate candidates for stenting. The aim of the present study was to evaluate a new strategy using this biomarker for the indication of stenting even without a significant pressure gradient.

Material and methods: Consecutive patients with disabling VPT were included from 2016 to 2019 and analyzed retrospectively. Intrasinusal pressures were measured and blood flow velocities (with a dual-sensor guidewire) were used for the indication of stenting independent of the pressure gradient. We evaluated the clinical outcome after stenting based on this new biomarker.

Results: A total of 41 patients were treated according to this strategy. At last follow-up (mean = 30.2 months), 32/33 patients (97%) treated by stenting showed complete resolution or a significant decrease in VPT intensity. The use of velocity as the threshold for indicating stenting identified 8 patients (24%) missed by the pressure gradient. Their clinical outcome after stenting was excellent and no complications occurred.

Conclusion: Measurement of sinus blood flow velocity provides a hemodynamic explanation of disease and may be a better tool than pressure gradient for the indication of stenting in VPT.

Keywords: Biomarker; Idiopathic intracranial hypertension; Intravascular velocity; Lateral sinus stenosis; Trans-stenotic pressure gradient.

MeSH terms

  • Blood Flow Velocity
  • Constriction, Pathologic / surgery
  • Cranial Sinuses
  • Hemodynamics
  • Humans
  • Retrospective Studies
  • Stents / adverse effects
  • Tinnitus* / diagnostic imaging
  • Tinnitus* / etiology
  • Tinnitus* / surgery
  • Treatment Outcome