Utilizing intravascular ultrasound for optimizing patient selection in venous sinus stenting: A pilot study

In a retrospective observational pilot study Turpin et al. from the Zucker School of Medicine, Northwell Health, Great Neck, NY published in the Interventional Neuroradiology Journal to assess the utility of intravascular ultrasound (IVUS) versus conventional angiography in quantifying venous sinus stenosis and predicting physiologically significant pressure gradients in patients considered for venous sinus stenting (VSS). IVUS provided higher sensitivity and stronger correlation with manometry-derived pressure gradients than angiography. The authors propose IVUS as a superior, objective adjunct for evaluating VSS candidacy ¹⁾.

This single-center retrospective analysis of 31 patients compares IVUS to traditional angiography in measuring venous sinus stenosis severity and correlating these with pressure gradients in idiopathic intracranial hypertension (IIH) and pulsatile tinnitus (PT). While the rationale is compelling—addressing known variability in angiographic assessment—the study’s design is inherently limited.

Major limitations include the small sample size, retrospective nature, and lack of blinded measurement validation. The correlation between IVUS measurements and pressure gradients (r = 0.78) is statistically superior to that of angiography (r = 0.46), but sensitivity/specificity analysis is overly optimistic given the modest population and unvalidated cutoff (53.2% stenosis). Absence of outcome data (i.e., clinical improvement post-stenting) further weakens claims of enhanced patient selection. Additionally, the interobserver variability for angiography being poor (r² = .19) highlights an important, but long-known issue that IVUS may ameliorate. However, without long-term follow-up or prospective validation, the utility of IVUS remains theoretical.

Rating: 4.5 / 10

Takeaway for Neurosurgeons: IVUS shows promise as a more objective tool for assessing venous sinus stenosis, potentially improving selection criteria for VSS. However, its real-world impact on outcomes and decision-making awaits validation.

Bottom Line: A hypothesis-generating pilot with intriguing findings, but insufficient evidence to alter clinical practice or protocols at this stage.

Publication Date: June 30, 2025

Corresponding Author Email: athos.patsalides@northwell.edu