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

Area of Science:

• Neurosurgery
• Vascular Neurology
• Medical Imaging

Background:

• Lateral sinus stenosis is the primary cause of venous pulsatile tinnitus (VPT).
• Stenting offers effective VPT treatment, traditionally guided by trans-stenotic pressure gradients.
• Pressure gradient measurements present significant technical challenges and limitations.

Purpose of the Study:

• To evaluate a novel strategy for stenting indication in VPT.
• To utilize intravascular velocity measurement as a primary biomarker, independent of pressure gradients.
• To assess the efficacy of stenting in patients selected by this new velocity-based criterion.

Main Methods:

• Retrospective analysis of consecutive patients with disabling VPT (2016-2019).
• Intrasinusal pressures and blood flow velocities were measured using a dual-sensor guidewire.
• Stenting indications were determined by velocity thresholds, bypassing traditional pressure gradient requirements.

Main Results:

• 41 patients were treated using the velocity-based strategy.
• 97% of stented patients (32/33) experienced complete VPT resolution or significant reduction.
• The velocity method identified 8 patients (24%) who would have been missed by pressure gradients, with excellent outcomes and no complications.

Conclusions:

• Sinus blood flow velocity measurement offers a hemodynamic basis for VPT.
• Velocity assessment may be a more effective tool than pressure gradients for guiding stenting in VPT.
• This biomarker-guided approach enhances patient selection for stenting, improving clinical results.