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Clinical Neuroradiology
Published in: Clinical Neuroradiology 3/2023

01-03-2023 | Tinnitus | Original Article

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

Authors: Alexis Guédon, Thomas Checkouri, Matteo Fantoni, Vittorio Civelli, Marc-Antoine Labeyrie, Jean-Pierre Saint-Maurice, Fabrice Vallée, Emmanuel Houdart

Published in: Clinical Neuroradiology | Issue 3/2023

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Abstract

Background and Purpose

Lateral sinus stenosis is the most common cause of venous pulsatile tinnitus (VPT). Stenting is an effective treatment after demonstration of a trans-stenotic pressure gradient; however, pressure measurement has many technical limitations. In 2018, a study showed that a combined approach with intravascular velocity measurement could be effective in identifying most appropriate candidates for stenting. The aim of the present study was to evaluate a new strategy using this biomarker for the indication of stenting even without a significant pressure gradient.

Material and Methods

Consecutive patients with disabling VPT were included from 2016 to 2019 and analyzed retrospectively. Intrasinusal pressures were measured and blood flow velocities (with a dual-sensor guidewire) were used for the indication of stenting independent of the pressure gradient. We evaluated the clinical outcome after stenting based on this new biomarker.

Results

A total of 41 patients were treated according to this strategy. At last follow-up (mean = 30.2 months), 32/33 patients (97%) treated by stenting showed complete resolution or a significant decrease in VPT intensity. The use of velocity as the threshold for indicating stenting identified 8 patients (24%) missed by the pressure gradient. Their clinical outcome after stenting was excellent and no complications occurred.

Conclusion

Measurement of sinus blood flow velocity provides a hemodynamic explanation of disease and may be a better tool than pressure gradient for the indication of stenting in VPT.
Appendix
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Metadata
Title
Blood Flow Velocity: a Decision Tool for Stenting Indication in Venous Pulsatile Tinnitus
Authors
Alexis Guédon
Thomas Checkouri
Matteo Fantoni
Vittorio Civelli
Marc-Antoine Labeyrie
Jean-Pierre Saint-Maurice
Fabrice Vallée
Emmanuel Houdart
Publication date
01-03-2023
Publisher
Springer Berlin Heidelberg
Published in
Clinical Neuroradiology / Issue 3/2023
Print ISSN: 1869-1439
Electronic ISSN: 1869-1447
DOI
https://doi.org/10.1007/s00062-023-01268-0

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