Trans-stenotic pressure gradient in symptomatic transverse sinus stenosis: clinical, laboratory, and imaging...

The trans-stenotic pressure gradient (TPG) is a critical pathophysiological factor in symptomatic transverse sinus stenosis (TSS) and serves as a principal hemodynamic indicator for determining the necessity of stent placement. However, the gold standard of TPG measurement requires venous manometry guided by digital subtraction angiography, which is an invasive procedure associated with significant technical complexity, substantial cost, and procedural risks. In recent years, there has been growing interest in noninvasive image-based TPG estimation methodologies. However, a comprehensive multivariate analysis incorporating clinical parameters, laboratory biomarkers, and imaging indicators remains conspicuously absent in recent research. The purpose of this study was to investigate the clinical, laboratory, and imaging parameters that exhibit correlations with the TPG in TSS.

Inpatients diagnosed with idiopathic intracranial hypertension or venous pulsatile tinnitus who underwent computed tomography venography (CTV) between September 2016 and October 2023 were retrospectively reviewed. Those with confirmed TSS and who subsequently underwent venous manometry were included. The comparison of parameters between genders was performed through the use of independent samples t-tests for continuous data and chi-squared tests for categorical data. We analyzed the correlation of the TPG with clinical characteristics (pulsatile tinnitus side, gender, age, and body mass index), laboratory results (blood glucose, blood lipid, routine blood examination, laboratory thyroid function test, coagulation test, and serum sex hormone levels), and CTV signs (the degree, length, and type of TSS; outflow laterality of the transverse sinus; and confluence point of the Labbé vein). Independent variables were determined, and a multivariate linear regression model was applied to assess their influences on TPG.

The study cohort comprised 95 participants (11 males and 84 females) with a median age of 38 years (interquartile range, 31-49 years). Body mass index (BMI) (P=0.004), hemoglobin (P=0.018), testosterone (P=0.004), and prolactin (P<0.001) were significantly different between genders, while the other parameters were not. The TPG was significantly correlated with age (R=-0.36; P<0.001), the degree of TSS (R=0.53; P<0.001), length of TSS (R=0.36; P<0.001), intrinsic stenosis (R=-0.21; P=0.038), an upstream location of the Labbé vein (R=-0.28; P=0.006), levels of free tetraiodothyronine (R=0.30; P=0.004), triiodothyronine (R=-0.27; P=0.008), D-dimer (R=-0.22; P=0.035), follicle-stimulating hormone (R=-0.28; P=0.006), luteinizing hormone (R=-0.29; P=0.004), and prolactin (R=0.25; P=0.016). After multicollinearity testing and variable adjustment, the degree of TSS, age, and triiodothyronine level were included in the final regression model, resulting in the following equation: y _TPG = 7.42 + 11.04x _{degree of TSS} - 0.12x _age - 0.03x _{triiodothyronine} (R=0.67; P<0.001).

The degree of TSS, patient age, and triiodothyronine level are independently correlated with TPG in patients with symptomatic TSS.