Application of "Olive ⁃ Tipped" technique during cerebral venous sinus stenosis stenting

Abstract

Objective To explore the clinical significance of "Olive ⁃ Tipped" technique during cerebral venous sinus stenosis stenting. Methods A total of 79 patients (including 57 patients with intracranial hypertension and 22 patients with pulsatile tinnitus) who were diagnosed with cerebral venous sinus stenosis (VSS) and underwent stenting in Department of the First Medical Center of Chinese PLA General Hospital from January 2017 to May 2021 were retrospectively collected. The characteristics of Labbe vein in patients with "Olive⁃Tipped" technique, the changes of pressure difference at both ends of stenosis before and after surgery in patients with intracranial hypertension were analyzed. The improvement of postoperative stenosis and venous reflux, the improvement of postoperative intracranial hypertension and pulsatile tinnitus, the success rate of stenting and the utilization rate of "Olive ⁃ Tipped" technique were observed. Results All the stents were successfully placed (79/79). Immediate DSA after procedure showed no venous stasis in all patients, and residual stenosis was < 30%. "Olive⁃Tipped" technique was used in 23 patients (29.11%) to assist the stent in place due to the guiding catheter and stent could not reach the predetermined position smoothly. The diameter of the confluence of Labbe vein and venous sinus in the "Olive⁃Tipped" technique group was significantly larger than that in the conventional technique group (t = 7.041, P = 0.000). The pressure difference between the two ends of venous sinus stenosis in patients with intracranial hypertension was 15.00 (11.00, 21.50) mm Hg before surgery and 1 (0, 2) mm Hg immediately after surgery, the difference was statistically significant (Z = ⁃ 6.573, P = 0.000). The tinnitus sympoms of 22 patients with pulsatile tinnitus caused by cerebral venous sinus stenosis disappeared immediately or visibly lightened. Conclusions The diameter of the confluence of Labbe vein and venous sinus can be used as an index to evaluate whether the stent is easy to implant before the surgery. The dilated Labbe vein confluence is easy to cause the guiding catheter and stent to get stuck, and the stent is difficult to be in place. The use of "Olive⁃Tipped" technique can significantly improve the success rate of the surgery.

doi：10.3969/j.issn.1672⁃6731.2022.06.006