Stenting for Intracranial Hypertension

While Intracranial Hypertension may not have an official cure, there are still a few treatment options available that have been known to relieve symptoms. One of these options is a surgical procedure known as stenting.

Our brains contain large veins called ‘venous sinuses’ which are responsible for draining blood and spinal fluid from our head, through the jugular in our neck, and to our heart. The narrowing of these passageways is known as venous sinus stenosis, stenosis meaning ‘narrowing’.

Once these veins narrow, CSF flow becomes impaired, causing intracranial pressure to increase, also known as Intracranial Hypertension. However, the cause of this narrowing can also be a result of increased CSF fluid applying a narrowing pressure on these veins, which only makes the existing IH worse. It’s a bit of a “chicken or the egg” situation.

Whichever way you look at it, if a patient is experiencing stenosis, stenting is often the go-to procedure for relieving this issue as well as the Pulsatile Tinnitus that tends to occur with it.

A stent is a tiny, expandable tube that can be placed in the narrowed portion of the vein to open it back up and allow things to flow more properly.

Procedure

Stenting is done during a cerebral angiogram. It typically only requires mild sedation, in which you may be somewhat aware yet relaxed and mostly pain free.

A catheter is inserted into your groin or wrist and threaded up to the narrowed part of the vein. This catheter is like a type of small, deflated balloon with the stent wrapped around it. Once at the desired location, this balloon will inflate, officially placing the stent and opening the vein. The catheter will then be removed and the entrance site sealed.

Recovery

Following stent placement, you will be advised to remain lying flat to allow your body time to recover. You will be placed on blood thinners and likely remain in the ICU for several days where you will be properly monitored and issued pain medication as needed. Bruising and hematomas at the entrance site can be expected, though never hesitate to report any concerns to your healthcare team.

Keep in mind every doctor will have different orders. Some patients may go home much sooner. Some may also be given different instructions as far as blood thinners go.

Cons

While many patients have found complete relief after stenting, this surgery definitely isn’t for everyone.

One reason is because you have to actually be a candidate for it. There must be a certain measure of pressure from the narrowing (called a gradient) in order for your neurosurgeon to consider it necessary or beneficial. If there is no stenosis present at all, then there is no reason to stent.

Second, stenting one location does not guarantee another one wont narrow.

And thirdly, this procedure does require that the patient take anti-platelets (blood thinners), which not everyone can safely take.

My Experience

This was one procedure I was very close to having. In February of 2018, my symptoms had gotten so bad that my doctors wanted to see if stenting would help.

It was not my first angiogram, but it was the one that would determine whether or not I was a candidate for a stent. I was told that if they discovered the gradient was significant enough during this procedure, the stent would be placed right then and there. I would  then be kept in ICU to be closely monitored and given pain medication as needed. I was told to expect some quite painful headaches for about a week before being discharged and placed on blood thinners for the rest of my life.

I was mostly aware throughout the procedure and not very concerned. For the most part, you don’t feel much. However, every now and then, there was the feeling that they may have hit a nerve. But after all of the head pain that comes with IIH, this was nothing new. There were also times that I could hear some scraping within my head as the catheter traveled through my veins.

The procedure took longer than my previous angiogram as the physicians had to call a ‘time out’ in order to debate whether the stent was worth it or not. In the end, they decided the cons would outweigh the pros.

I continued to lay flat for an hour or two to allow the groin wound more time to heal. I had a pretty bad hematoma following mine, but thankfully it resolved, and over time the massive bruise disappeared.

While at first it seemed disappointing that this could not be my cure, I was actually thankful to not have to live on blood thinners for the rest of my life. My goal was always to get off all of my medications. And for some reason, this procedure just didn’t seem like the one for me anyway.