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

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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.

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Abbreviations

IIH:

Idiopathic intracranial hypertension

LSS:

Lateral sinus stenosis

RMV :

Mean blood flow velocity ratio

TSG:

Trans-stenotic pressure gradient

VAS:

Visual analogue scale

VPT:

Venous pulsatile tinnitus

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Author information

Authors and Affiliations

  1. Department of Neuroradiology, AP-HP, Lariboisière Hospital, 2, rue Ambroise Paré, 75010, Paris, France

    Alexis Guédon, Thomas Checkouri, Matteo Fantoni, Vittorio Civelli, Marc-Antoine Labeyrie, Jean-Pierre Saint-Maurice & Emmanuel Houdart

  2. School of Medicine, Université Paris Cité, 75006, Paris, France

    Alexis Guédon & Emmanuel Houdart

  3. Inserm, UMR_S 1140, Université Paris Cité, 75006, Paris, France

    Alexis Guédon

  4. Department of Anesthesiology and Critical Care, AP-HP, Lariboisière Hospital, 75010, Paris, France

    Fabrice Vallée

  5. Inserm, UMR_S 942, Université Paris Cité, 75006, Paris, France

    Fabrice Vallée

  6. LMS Polytechnique and M3DISIM, Inria, Paris-Saclay University, CEA, Palaiseau, France

    Fabrice Vallée

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  1. Alexis Guédon
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Contributions

A. Guédon, T. Checkouri, F. Vallée, E. Houdart: designed and conceptualized study, acquisition of data, analyzed and interpreted the data, drafted the manuscript for intellectual content. M. Fantoni, V. Civelli, M.-A. Labeyrie, J.-P. Saint-Maurice: revised the manuscript for intellectual content.

Corresponding author

Correspondence to Alexis Guédon.

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Conflict of interest

A. Guédon, T. Checkouri, M. Fantoni, V. Civelli, M.-A. Labeyrie, J.-P. Saint-Maurice, F. Vallée and E. Houdart declare that they have no competing interests concerning the materials or methods used in this study or the findings specified in this paper.

Ethical standards

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the institutional review board and patient informed consent was waived.

Additional information

Alexis Guédon and Thomas Checkouri contributed equally to the work.

Availability of Data and Material

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Guédon, A., Checkouri, T., Fantoni, M. et al. Blood Flow Velocity: a Decision Tool for Stenting Indication in Venous Pulsatile Tinnitus. Clin Neuroradiol 33, 729–737 (2023). https://doi.org/10.1007/s00062-023-01268-0

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