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Dural sinus septum: an underlying cause of cerebral venous sinus stenting failure and complications

Yangang Zhao, Xiaolan Zhang, Bin Lv, Jun Wang, Xinfeng Liu, Zhihua Du, Fang Cui, Baoming Li, Xing Chen, Xiangyu Cao
DOI: 10.1136/svn-2023-002407 Published 30 April 2024
Yangang Zhao
1 Beijing Advanced Innovation Center for Biomedical Engineering, School of Engineering Medicine, Beihang University, Beijing, China
2 Department of Neurology, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China
3 Department of Neurology, Chinese PLA General Hospital, Beijing, China
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Xiaolan Zhang
3 Department of Neurology, Chinese PLA General Hospital, Beijing, China
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Bin Lv
3 Department of Neurology, Chinese PLA General Hospital, Beijing, China
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Jun Wang
3 Department of Neurology, Chinese PLA General Hospital, Beijing, China
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Xinfeng Liu
3 Department of Neurology, Chinese PLA General Hospital, Beijing, China
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Zhihua Du
3 Department of Neurology, Chinese PLA General Hospital, Beijing, China
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Fang Cui
2 Department of Neurology, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China
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Baoming Li
2 Department of Neurology, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China
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Xing Chen
1 Beijing Advanced Innovation Center for Biomedical Engineering, School of Engineering Medicine, Beihang University, Beijing, China
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Xiangyu Cao
3 Department of Neurology, Chinese PLA General Hospital, Beijing, China
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    Figure 1

    Flow diagram of the study design.

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    Figure 2

    The classification and DSA imaging of venous sinus septa. (A) Frontal and (B) lateral schematics of type I: septa at transverse sinus, type II: septa at transverse–sigmoid sinus junction and type III: septa at sigmoid sinus. (C) Frontal angiogram of type I. (D) Frontalangiogram of type II. (E) Lateral angiogram of type III. DSA, digital subtraction angiography.

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    Figure 3

    Images of Case 1 and animation of complication reasoning. (A) The sinus stenosis at the right transverse–sigmoid junction (arrow) and the venous sinus septal lumen (type I, thick arrow). (B) Occluded right transverse sinus (arrow). (C) Subdural haemorrhage (arrow). (D) Dilatated balloon (arrow) in the occluded sinus segment. (E, F) Frontal and lateral angiograms of the partially recanalised venous sinus (arrow). (G) The schematic of a septum at the right transverse sinus (type I). (H) The schematic of the occluded and torn transverse sinus after stenting into the septal lumen.

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    Figure 4

    Images of Case 2 and animation of complication reasoning. (A) The sinus stenosis at the right transverse–sigmoid junction (arrow). (B) Fully dilated balloon at the stenotic segment (arrow). (C) Fluoroscopy image of an incompletely expanded stent (arrow). (D) VasoCT scan image of the stent cramped at the central segment (arrow). (E) The schematic of a septum at the transverse–sigmoid sinus junction (type II). (F) The schematic of the incomplete stent expansion at the septal lumen.

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    Figure 5

    Images of Case 3. The sinus stenosis at the right transverse–sigmoid junction (arrow). (B) The septum at the sigmoid sinus (arrow). (C) The microcatheter through the main lumen of the sigmoid sinus (arrow). (D, E) Frontal and lateral angiograms of the expanded stent in the venous sinus (arrow). (F) Fluoroscopic image of the incompletely expanded proximal end of the stent (arrow).

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    Figure 6

    Animation of the slide-test technique. (A) When placed in the venous sinus lumen, the partially dilated balloon can freely slide back and forth. (B) When placed in the septal lumen, the partially dilated balloon gets stuck and should be withdrawn.

Tables

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  • Table 1

    Baseline clinical characteristics

    Clinical characteristicsMeans±SD (min–max) or n%
    Female, n (%)30 (93.8)
    Age (mean±SD), years20–57 (37.3±9. 5)
    Clinical duration (mean±SD), months0.2–360 (30.0±66.2)
    Preoperative symptoms
    Headache, n (%)10 (31.2)
    Dizziness, n (%)4 (12.5)
    Visual dysfunction, n (%)14 (43.8)
    Pulsatile tinnitus, n (%)14 (43.8)
    Temporary amaurosis, n (%)3 (9.4)
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Vol 9 Issue 2 Table of Contents
Stroke and Vascular Neurology: 9 (2)
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Dural sinus septum: an underlying cause of cerebral venous sinus stenting failure and complications
Yangang Zhao, Xiaolan Zhang, Bin Lv, Jun Wang, Xinfeng Liu, Zhihua Du, Fang Cui, Baoming Li, Xing Chen, Xiangyu Cao
Stroke and Vascular Neurology Apr 2024, 9 (2) 174-180; DOI: 10.1136/svn-2023-002407

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Dural sinus septum: an underlying cause of cerebral venous sinus stenting failure and complications
Yangang Zhao, Xiaolan Zhang, Bin Lv, Jun Wang, Xinfeng Liu, Zhihua Du, Fang Cui, Baoming Li, Xing Chen, Xiangyu Cao
Stroke and Vascular Neurology Apr 2024, 9 (2) 174-180; DOI: 10.1136/svn-2023-002407
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Dural sinus septum: an underlying cause of cerebral venous sinus stenting failure and complications
Yangang Zhao, Xiaolan Zhang, Bin Lv, Jun Wang, Xinfeng Liu, Zhihua Du, Fang Cui, Baoming Li, Xing Chen, Xiangyu Cao
Stroke and Vascular Neurology Apr 2024, 9 (2) 174-180; DOI: 10.1136/svn-2023-002407
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