Clinical indications and patient outcomes of intracranial venous sinus stenting beyond overt idiopathic intracranial hypertension: a scoping review

Abstract

Background

Intracranial venous sinus stenting (VSS) was initially developed as an alternative approach to addressing venous outflow obstruction in the context of idiopathic intracranial hypertension (IIH). In recent years, the technique has been increasingly used for other conditions involving venous compromise beyond overt IIH. The aim of this study was to describe the nature and volume of literature considering clinical applications and efficacy of VSS.

Methods

A scoping review was conducted using MEDLINE, EMBASE, Scopus, The Cochrane Library, and various grey literature sources. Articles published since the introduction of VSS in 2002 were included. Independent screening of articles occurred in two stages: title-and-abstract and full-text screening. Relevant data was extracted and evidence mapping with narrative synthesis followed.

Results

The search strategy yielded 1814 articles, of which 165 were included in this review. A total of 27 additional clinical indications of VSS beyond overt IIH were identified, spanning a diverse range of neurological pathology. Most evidence came from case reports, with the United States being the commonest study origin. Focal stenotic lesions and stenting locations were distributed throughout the dural sinus anatomy. An outline of patient outcomes reported by VSS providers is presented, with pulsatile tinnitus and visual impairment showing the greatest likelihood of clinical resolution.

Conclusion

This scoping review demonstrates the wider clinical utility and therapeutic potential of VSS beyond overt IIH. We also highlight the need for further studies to assess efficacy for each respective indication and clinical standardisation of VSS practice.