Venous Sinus Stenting Using a Ledge-Reducing Catheter, 0.088-in. Catheter-Extender With an External Single Point of Control: Technique and Multicenter Clinical Experience.

Background: Venous sinus stenting (VSS) is increasingly performed for managing venous sinus stenosis associated with refractory idiopathic intracranial hypertension and/or pulsatile tinnitus. The Monopoint System (MS; Route 92 Medical, San Mateo, CA) is a telescoping catheter system with a single point of control outside the body, consisting of an 8F Guide Catheter (Base Camp), a 0.088-in. inner diameter catheter-extender (HiPoint 88), and a ledge-reducing delivery catheter (Tenzing 8). In this study, we describe the MS technique for VSS and our multicenter clinical experience. Methods: We retrospectively reviewed consecutive patients who underwent VSS with the MS from 2022 to 2023 for intracranial hypertension and/or pulsatile tinnitus at 13 sites. Base Camp is placed in the internal jugular bulb. HiPoint 88 is advanced over the Tenzing 8 through the stenosis. The stent-delivery system is placed across the stenosis (inside the HiPoint 88), then unsheathed by HiPoint pull-back, followed by successful stent deployment. Operators were also surveyed on MS performance. Results: Seventy-one patients were included, 97% female, mean age 40 ± 11 years, body mass index 35 ± 11. The primary indication for venous stenting was intracranial hypertension (79%, 56/71) and/or debilitating pulsatile tinnitus (87%, 62/71). Visual changes were present in 74%, with papilledema in 63%. Hipoint 88 advanced beyond the stenosis over Tenzing 8 in all cases, and all stents (diameters 6-10 mm and lengths 30-80 mm) successfully deployed. Median stenosis decreased from 80% (interquartile range 75-87) to 0% (interquartile range 0-0) post stenting (P<0.001). There were no Monopoint-related complications. compared with the operators' typical VSS catheter setup/technique, MS was rated "better" in 93% and "slightly better" in 6%; operators cited ease of crossing the stenosis, improved trackability and support, as well as lack of stent-catheter length incompatibilities. Headache, pulsatile tinnitus, and papilledema improved in 81%, 95%, and 91%, respectively. Conclusion: The MS is a safe and effective catheter platform for VSS.