Plain English Summary
Background and study aims
Intracranial hypertension (IH) describes abnormally high pressure inside the skull. Symptoms of IH include severe throbbing headaches that are worse in the morning and changes in vision. There are various recognised causes of IH, such as a brain tumour or brain infection. Sometimes there is no obvious cause of IH, and in these instances it is described as idiopathic intracranial hypertension (IIH). Severe narrowing (stenosis) of the vein (transverse-sigmoid) sinuses on both sides of the head has been recognised as a potential cause of IIH. One way to treat narrow vein sinuses in IIH is to surgically insert stents into them. A stent is a small mesh tube that is often used to widen narrow blood vessels, such as arteries. Stenting in IIH may help normalise the pressure of cerebrospinal fluid (CSF), the liquid which fills and surrounds the brain. Normalisation of CSF may help reduce the visual symptoms and headaches associated with IIH in patients. The aim of this study is to see how effective and safe venous sinus stenting is in patients that have not responded to other types of treatment for IIH.
Who can participate?
Adults diagnosed with IIH.
What does the study involve?
All participants have venous sinus stenting surgery. Participants complete questionnaires and attend follow up 1 month after treatment, then again at 3, 6 and 12 months.
What are the possible benefits and risks of participating?
Research studies such as this are performed to determine how safe and effective a specific medical treatment or device is. No direct benefit to participants can be guaranteed. The risks associated with the stent procedure (including those associated with the cerebral angiogram) include transient neurological deficit, permanent neurological deficit (or stroke), hearing loss, unsteadiness, cerebral bleeding, death, contrast material (X-ray dye) or drug allergic reaction, kidney failure, infection, cerebral venous stroke or blockage to the artery in the leg requiring surgical repair or the need for blood transfusion. All risks will be fully discussed with participants.
Where is the study run from?
Hospital Center University of Quebec - Hospital of the Child Jesus (CHU de Québec - Hôpital de l'Enfant-Jésus) (Canada)
When is the study starting and how long is it expected to run for?
September 2010 to January 2015
Who is funding the study?
1. Canadian Heads of Academic Radiology/GE Healthcare Development Program (Canada)
2. Laval University - Department of Medical Imaging (Université Laval) (Canada)
Who is the main contact?
Dr P Lavoie
Trial website
Additional identifiers
EudraCT number
ClinicalTrials.gov number
Protocol/serial number
2012-1482
Study information
Scientific title
Stenting of venous sinus stenosis for medically refractory idiopathic intracranial hypertension: a cohort study
Acronym
Study hypothesis
Severe bilateral stenosis of the transverse-sigmoid sinuses has been recognised as a potential etiology of idiopathic intracranial hypertension (IIH). The treatment and prevention of these stenosis by venous sinus stenting may be effective in normalising the cerebrospinal fluid (CSF) pressure, reducing visual symptoms and headaches in patients with IIH refractory to other treatment.
Ethics approval
Ethics Committee of Hospital Center University of Quebec (Centre Hospitalier Universitaire (CHU) de Québec), 12/01/2011, ref: 2012-1482, PEJ-578.
Study design
Cohort study
Primary study design
Interventional
Secondary study design
Non randomised study
Trial setting
Hospitals
Trial type
Treatment
Patient information sheet
Not available in web format, please use contact details to request a participant information sheet.
Condition
Idiopathic intracranial hypertension
Intervention
Endovascular venous sinus stenting.
Intervention type
Procedure/Surgery
Phase
Drug names
Primary outcome measure
CSF pressure normalisation at 6 months follow up. CSF pressure will be measured by lumbar puncture at the start of the trial and 6 months after the stenting. A normalisation is defined as at least a 15 mmHg difference between pre- and post-op lumbar puncture.
Secondary outcome measures
1. Significant decrease in CSF pressure at 6 months
2. Improvement of visual fields, visual acuity, vision color, visual evoked potential at 3 months and 12 months
3. Improvement of papilloedema (according to Frisén scale) at 3 months and absence of papilloedema at 12 months, with improvement of OCT
4. Resolution of visual complaints (transient visual losses, visual obscurations, poor vision, blurring of vision etc.) at 12 months
5. Decrease of headaches score (HIT-6) and severity at 12 months
6. Improvement in Quality of Life at 12 months
7. 12 months stent patency on CT-Venous angiogram
8. Safety and treatment side effects immediately after intervention and at 1 month (evaluated in neurology), and modified Rankin scale immediately after intervention and at 1 month.
Overall trial start date
01/09/2010
Overall trial end date
05/01/2015
Reason abandoned (if study stopped)
Eligibility
Participant inclusion criteria
1. Patients aged 18 and over with diagnosis of IIH according to Friedman diagnostic criteria for whom standard medical treatment has failed (defined as persistent headaches or visual symptoms or papilloedema in spite of 3 months treatment with Diamox or intolerance of side effect of the medication)
2.Venous imaging (CT, MR or standard venography) showing bilateral transverse sinus stenoses or unilateral transverse sinus stenosis with contralateral transverse sinus atresia. At least one of the stenosis must cause >50% reduction of the sinus lumen.
3. Pressure gradient across the stenosis >8 mmHg
4. Signed informed consent obtained from the patient
Participant type
Patient
Age group
Adult
Gender
Both
Target number of participants
33
Participant exclusion criteria
1. Allergic reaction to iodine contrast despite premedication
2. Contraindication to general anaesthesia
3. Contraindication to aspirin, Clopidogrel (Plavix®) or anticoagulants
4. Patient with medical history of intracranial venous thrombosis (which do not correspond to idiopathic intracranial hypertension and increase risk of venous stent thrombosis)
5. Pregnant women
Recruitment start date
20/09/2011
Recruitment end date
12/03/2014
Locations
Countries of recruitment
Canada
Trial participating centre
Hospital Center University of Quebec - Hospital of the Child Jesus (CHU de Québec - Hôpital de l'Enfant-Jésus)
1401 18E street
Québec
G1J 1Z4
Canada
Funders
Funder type
Other
Funder name
Canadian Heads of Academic Radiology/GE Healthcare Development Program (Canada)
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Funder name
Laval University - Department of Medical Imaging (Université Laval) (Canada)
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Results and Publications
Publication and dissemination plan
An article will be submitted to Stroke journal and the results will be presented at a national conference such as The Canadian Society for Neurological Sciences.
Intention to publish date
01/06/2015
Participant level data
Available on request
Basic results (scientific)
Publication list
2018 adverse event report in https://pubmed.ncbi.nlm.nih.gov/28992723/ (added 17/12/2020)