Endovascular stenting using a sagittal sinus approach for sigmoid sinus wall dehiscence related to intractable pulsatile tinnitus: a case series.

BACKGROUND: Sigmoid sinus wall dehiscence can lead to pulsatile tinnitus with a significant decrease in quality of life, occasionally leading to psychiatric disorders. Several surgical and endovascular procedures have been described for resolving dehiscence. Within endovascular procedures, the sagittal sinus approach could be a technical alternative for tracking and accurate stent positioning within the sigmoid sinus when the jugular bulb anatomy is unfavorable. CASE PRESENTATION: A retrospective case series of three patients with pulsatile tinnitus due to sigmoid sinus wall dehiscence without intracranial hypertension was reviewed from January 2018 to January 2022. From the participants enrolled, the median age was 50.3 years (range 43-63), with 67% self-identifying as female and 33% as male. They self-identified as Hispanic. Sigmoid sinus dehiscence was diagnosed using angiotomography, and contralateral transverse sinus stenosis was observed in all patients. Patients underwent surgery via a navigated endovascular sagittal sinus approach for sigmoid sinus stenting. No neurological complications were associated with the procedure. Pulsatile tinnitus improved after the procedure in all patients. CONCLUSIONS: Superior sagittal sinus resection for sigmoid sinus wall stenting is a safe and effective technique. Pulsatile tinnitus due to sigmoid sinus wall dehiscence could be treated using the endovascular resurfacing stenting technique. However, further research is needed to evaluate the potential benefit of contralateral stenting for removing sinus dehiscence when venous stenosis is detected. However, resurfacing sigmoid sinus wall dehiscence results in symptomatic improvement.

[Endovascular management of carotid atherosclerosis. Section I: basic considerations and diagnostic elements]. / Manejo endovascular de la aterosclerosis carotídea Parte I. Consideraciones básicas y elementos diagnósticos.

Carotid atherosclerosis accounts for about 25 % of all ischemic cerebrovascular events. A thorough knowledge of the pathophysiology of the plaque and its clinical consequences are fundamental elements for a well-balanced approach of the management of the disease. The evolution of the imaging techniques allow to visualize the plaque and the analysis of its structure and characteristics. The awareness of the physiopathology and the understanding of the imaging modalities are key issues when planning the treatment of the patient.

[Endovascular management of carotid atherosclerosis. Section II: current therapeutic approaches and limitations]. / Manejo endovascular de la ateroesclerosis carotídea Parte II. Criterios terapéuticos actuales y limitaciones.

Carotid endarterectomy has for long been regarded as the gold standard for the management of symptomatic atherosclerosis of the carotid bifurcation, and carotid angioplasty is merely considered a secondary alternative reserved to surgically high-risk patients. However, several studies have shown that the efficacy of carotid angioplasty has equaled that of carotid endarerectomy and additionally provides unshared advantages: local anesthesia is sufficient, the whole extracranial and intracranial carotid circulation are amenable to treatment and wound-related complications are not seen. Besides a thorough review of the main published studies comparing both techniques, we provide updated criteria for the endovascular management of carotid artery disease, discussing their benefits and limitations.