Technical Considerations

Fig. 13. A case of a 9 year-old boy with a large dominant right transverse sinus. (A) Lateral DRCV demonstrating the significant right transverse sinus obstruction. There was a gradient of 11 mmHg across the obstruction. (B) Image during stent deployment. (C) Lateral DRCV of right transverse sinus with the stent fully deployed showing abolition of stenosis

Fig. 13. A case of a 9 year-old boy with a large dominant right transverse sinus. (A) Lateral DRCV demonstrating the significant right transverse sinus obstruction. There was a gradient of 11 mmHg across the obstruction. (B) Image during stent deployment. (C) Lateral DRCV of right transverse sinus with the stent fully deployed showing abolition of stenosis

We prefer to deploy the stent via a sheath in the right femoral vein. It may be difficult to guide the stent through the jugular foramen and sigmoid sinus due to the tight curvature and stiffness of the catheter. Alternatively, the jugular vein may be used. Another group have deployed venous sinus stents into the transverse sinus via a frontal burr-hole over the SSS in order to overcome this problem (Prof. Peter Reilly, Adelaide, Australia; personal communication). Once the stent is situated over the point of stenosis the balloon is inflated and the stent is deployed. Several inflations of the balloon may be necessary in order to achieve the desired result. Care must be taken when withdrawing the delivery device as it may catch the edge of the stent, particularly with self expanding stents, and pull it along the sinus distally. Once the stent is deployed venography is performed to assess the position of the stent and resolution of the stenosis. Venous sinus pressures are also recorded to ensure that the pressure gradient has resolved.

At the present time it is our practice to recover the patient and have them observed in the neurosurgical high-dependency unit overnight. Hepa-rin is either allowed to wear off or is continued for 24 hours. Aspirin is continued for at least six months. In adults, clopidigrel is given for one month.

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