National Trends in the Endovascular and Surgical Treatment of Idiopathic Intracranial Hypertension.

CSF Shunting Endovascular Venous Stenting Idiopathic Intracranial Hypertension National trend Optic Nerve Sheath Fenestration Pseudotumor cerebri

Journal

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
ISSN: 1532-8511
Titre abrégé: J Stroke Cerebrovasc Dis
Pays: United States
ID NLM: 9111633

Informations de publication

Date de publication:
13 Feb 2024
Historique:
received: 28 09 2023
revised: 04 12 2023
accepted: 13 02 2024
medline: 16 2 2024
pubmed: 16 2 2024
entrez: 15 2 2024
Statut: aheadofprint

Résumé

The pattern of surgical treatments for Idiopathic Intracranial Hypertension (IIH) in the United States is not well-studied, specifically the trend of utilizing endovascular venous stenting (EVS) as an emerging technique. In this cross-sectional study, we aimed to explore the national trend of utilizing different procedures for the treatment of IIH including EVS, Optic Nerve Sheath Fenestration (ONSF), and CSF Shunting, with a focus on novel endovascular procedures. Moreover, we explored rates of 90-day readmission and length of hospital stay following different procedures, besides the effects of sociodemographic and clinical parameters on procedure choice. 36,437 IIH patients were identified from records between 2010-2018. Those in the EVS group were 29 years old on average, and 93.4% were female. Large academic hospital setting was independently associated with higher EVS utilization, while other factors were not predictive of procedure choice. The proportion of EVS use in IIH hospitalizations increased significantly from 2010 to 2018 (P <0.001), while there was a relative decline in the frequency of shunting procedures (P =0.001), with ONSF utilization remaining stable (P=0.39). The rate of 90-day readmission and length of hospital stay were considerably lower following EVS compared to other procedures (Ps<0.001). This study presents novel population-level data on national trends in the frequency and outcome of EVS for IIH therapy. EVS was associated with shorter length of hospital stays and fewer readmission rates. In addition, a continuous increase in venous stenting compared to other procedures suggests an increasing role for endovascular therapies in IIH.

Sections du résumé

BACKGROUND BACKGROUND
The pattern of surgical treatments for Idiopathic Intracranial Hypertension (IIH) in the United States is not well-studied, specifically the trend of utilizing endovascular venous stenting (EVS) as an emerging technique.
METHODS METHODS
In this cross-sectional study, we aimed to explore the national trend of utilizing different procedures for the treatment of IIH including EVS, Optic Nerve Sheath Fenestration (ONSF), and CSF Shunting, with a focus on novel endovascular procedures. Moreover, we explored rates of 90-day readmission and length of hospital stay following different procedures, besides the effects of sociodemographic and clinical parameters on procedure choice.
RESULTS RESULTS
36,437 IIH patients were identified from records between 2010-2018. Those in the EVS group were 29 years old on average, and 93.4% were female. Large academic hospital setting was independently associated with higher EVS utilization, while other factors were not predictive of procedure choice. The proportion of EVS use in IIH hospitalizations increased significantly from 2010 to 2018 (P <0.001), while there was a relative decline in the frequency of shunting procedures (P =0.001), with ONSF utilization remaining stable (P=0.39). The rate of 90-day readmission and length of hospital stay were considerably lower following EVS compared to other procedures (Ps<0.001).
CONCLUSION CONCLUSIONS
This study presents novel population-level data on national trends in the frequency and outcome of EVS for IIH therapy. EVS was associated with shorter length of hospital stays and fewer readmission rates. In addition, a continuous increase in venous stenting compared to other procedures suggests an increasing role for endovascular therapies in IIH.

Identifiants

DOI: 10.1016/j.jstrokecerebrovasdis.2024.107637 PMID: 38360251
pubmed: 38360251
pii: S1052-3057(24)00082-X
doi: 10.1016/j.jstrokecerebrovasdis.2024.107637
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

107637

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.

Déclaration de conflit d'intérêts

Declaration of competing interest The authors of this study declared no conflicting or competing interest in the subject matter of this paper

Auteurs

Mohammad Hossein Abbasi (MH)

Department of Neurology, University of Texas at Austin Dell Medical School, Austin, TX, US. Electronic address: mh.abbasi@austin.utexas.edu.

Smit D Patel (SD)

Department of Neurology, Hartford Hospital, Hartford, CT, US. Electronic address: drsmitpatel1988@gmail.com.

Ramsey R Ashour (RR)

Department of Neurosurgery, University of Texas at Austin Dell Medical School, Austin, TX, US. Electronic address: rashour@ascension.org.

Jefferson Miley (J)

Department of Neurology, University of Texas at Austin Dell Medical School, Austin, TX, US. Electronic address: jefferson.miley@austin.utexas.edu.

David Paydarfar (D)

Department of Neurology, University of Texas at Austin Dell Medical School, Austin, TX, US. Electronic address: david.paydarfar@austin.utexas.edu.

Steven Warach (S)

Department of Neurology, University of Texas at Austin Dell Medical School, Austin, TX, US. Electronic address: steven.warach@austin.utexas.edu.

Hamidreza Saber (H)

Department of Neurology, University of Texas at Austin Dell Medical School, Austin, TX, US. Electronic address: Hamid.Saber@gmail.com.

Classifications MeSH