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Natural History of Bone Formation Following Venous Sinus Stenting
Adam Dmytriw1, Iman Kiani1, Hamza Salim1
1From the Nuffield Department of Surgical Sciences (A.D.), Medical Sciences Division, University of Oxford, Oxford, UK; Neuroendovascular Program (A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Neurointerventional & Neuroanalytics Consortium (NAN-C) (A.D.), School of Medicine, Toronto Metropolitan University, Toronto, ON; Students' Scientific Research Center (I.K.), Tehran University of Medical Sciences, Tehran, Iran; Department of Radiology (H.S., V.Y.), Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA; Department of Neuroradiology (H.S.), MD Anderson Medical Center, Houston, TX 77030, USA; Department of Neurology (S.F.), CUB Hôpital Erasme, Interventional neuroradiology (T.L.), CUB Hôpital Erasme, Service d'ORL et de chirurgie cervico-faciale (M.V.G.), CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium; University of Zagreb (L.K.), School of Medicine, Zagreb, Croatia; Department of Diagnostic and Interventional Radiology (M.P.), University Hospital Center Sestre milosrdnice, Zagreb, Croatia; Department of Neurology (C.B.), Inselspital, Bern University Hospital, University of Bern, Faculty of Medicine, Bern, Switzerland; Department of Neuroradiology (L.S.), Hôpitaux Universitaires Henri Mondor, Créteil, France; Department of Diagnostic Radiology (N.G.), McGill University, Montreal, QC, Canada and Department of Diagnostic and Interventional Neuroradiology (Y.B., B.L., A.G.), Erasme University Hospital, Brussels, Belgium.
Background:
Venous sinus stenting has emerged as a potential effective treatment for pulsatile tinnitus (PT) and idiopathic intracranial hypertension (IIH) secondary to venous sinus stenosis. Bone formation adjacent to the stent has been described in isolated case reports, but it has remained underexplored. This study aimed to characterize bone formation following venous sinus stenting.
Methods:
This retrospective observational study included consecutive patients who underwent venous sinus stenting for PT and/or IIH. Bone formation was assessed at each follow-up time point. Comparisons between patients with and without bone formation were performed using Mann-Whitney U test for continuous variables and Fisher's exact test for categorical variables. Univariate logistic regression was used to identify predictors of bone formation.
Results:
Twenty-one patients were included. Bone formation was observed in 12 (57%) patients at 3 months and 14 (67%) patients at 12 months. Patients with bone formation had a significantly greater maximum incomplete stent apposition compared to those without (median 1.9 mm [IQR: 1.4-3.0] vs. 0.9 mm [IQR: 0.6-1.5]; p=0.03). On logistic regression, each millimeter increase in maximum incomplete stent apposition was associated with 3.72-fold higher odds of bone formation (95% CI: 0.95-14.50; p=0.06). Symptom resolution at 12 months was similar between patients with and without bone formation (71% vs. 86%; p=0.62).
Conclusions:
Bone formation following venous sinus stenting is common, affecting two-thirds of patients at 12 months, was not associated with worse symptom resolution at 12 months, although longer follow-up is needed to characterize its long-term significance. Incomplete stent apposition could be associated with increased bone formation; however, this warrants confirmation in larger cohorts.
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