Novel Approach to Venous Stenting: Tigertriever Temporary Stenting for the Evaluation of Pulsatile Tinnitus

Abstract

Pulsatile tinnitus can be significantly functionally debilitating, with venous sinus stenosis being a largely underrecognized etiology. Establishing a direct cause‐effect relationship can be particularly challenging in pulsatile tinnitus cases without idiopathic intracranial hypertension, and with multifocal, bilateral venous sinus stenoses. Herein, we present a patient with pulsatile tinnitus and bilateral transverse‐sigmoid sinus stenoses on diagnostic angiogram. Temporary stenting using a Tigertreiver was utilized to localize the symptomatic segment. Patient reported resolution of pulsatile tinnitus after deploying the temporary stentriever within the left sigmoid sinus. Subsequently, permanent stenting of the left sigmoid sinus was preformed resulting in complete resolution of symptoms. We highlight the diagnostic challenges of patients presenting with pulsatile tinnitus and venous sinus stenoses, without idiopathic intracranial hypertension. While more experience is needed, temporary stenting may provide an improved method for assessing venous stenting efficacy in patients with pulsatile tinnitus.