[Percutaneous Transluminal Sinus Stenting for Sigmoid Sinus Stenosis Associated with Transverse-Sigmoid Sinus Dural...

We report a case of transverse sinus-sigmoid sinus dural arteriovenous fistula(T-S dAVF)with venous flow congestion, which was accompanied by sigmoid sinus stenosis and treated with percutaneous transluminal sinus stenting. A 76-year-old woman presented with dementia and disturbance of consciousness. Magnetic resonance imaging(MRI)on admission revealed subcortical edema in the left occipital lobe and angiography demonstrated a left T-S dAVF with right transverse sinus occlusion and sigmoid sinus stenosis. Hemodynamics of the shunt flow from several feeders demonstrated retrograde flow to the straight sinus and superior sagittal sinus, and antegrade flow into the left internal jugular vein. These hemodynamics caused cortical venous congestion and intracranial venous hypertension. We performed percutaneous transluminal sinus stenting for left sigmoid sinus stenosis. Immediately after stent placement, retrograde shunt flow to the straight sinus and superior straight sinus dramatically disappeared and cortical venous congestion improved. Follow-up angiography 1 year after treatment showed neither new development of T-S dAVF nor re-stenosis of the stent in the left sigmoid sinus, although some shunt flow remained. Percutaneous transluminal sinus stenting for sinus stenosis associated with dAVF appears effective to improve venous congestion and intracranial venous hypertension.