Patency of the vein of Labbé after venous stenting of the transverse and sigmoid sinuses

Abstract

BackgroundVenous sinus stenting is an emerging treatment for patients with idiopathic intracranial hypertension and evidence of venous stenosis. Stents placed across the transverse and sigmoid sinuses often cover the vein of Labbé (VOL), a major anastomotic vein draining the cerebral hemisphere. The patency of the VOL after stenting and its clinical implications are poorly understood.MethodsA retrospective analysis was performed of a prospectively collected database of patients undergoing venous sinus stenting. Pre- and post-stent angiography were compared to assess changes in VOL patency, clinical and radiographic outcomes.ResultsThe study cohort comprised 56 patients. The stent covered the VOL in 92.9% of cases. Thirty-two cases with VOL coverage had evaluable angiograms immediately after stent placement. Among these, VOL filled normally in 75.0%, exhibited diminished caliber with normal transit time in 3.1%, filled sluggishly in 18.8%, and was occluded in 3.1%. Follow-up was assessed in patients with at least 3 months' angiographic follow-up (46 patients, mean 7.2 months). Of these, normal filling was seen in 71.7%, diminished caliber in 26.1%, and sluggish filling in 2.2% of cases. Neither stent coverage of the VOL nor its patency immediately after stenting or at follow-up correlated with stent-adjacent stenosis. There were no neurological sequelae from coverage of the VOL or alteration of its drainage pattern.ConclusionsIn the majority of venous stenting cases involving the transverse and sigmoid sinuses, the VOL remains widely patent. Complete VOL occlusion rarely occurs after stenting and may not result in clinical sequelae. Stent coverage of the VOL should not deter the therapeutic use of venous sinus stenting.