Ep. 371 Transverse Sinus Stenting for Idiopathic Intracranial Hypertension with Dr. Aaron Bress
BackTable Vascular & Interventional2 Okt 2023

Ep. 371 Transverse Sinus Stenting for Idiopathic Intracranial Hypertension with Dr. Aaron Bress

In this episode, host Dr. Michael Barraza interviews neurointerventional radiologist Dr. Aaron Bress about transverse sinus stenting for benign intracranial hypertension. --- CHECK OUT OUR SPONSORS MicroVention FRED X https://www.fred-x.com/ RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES Aaron starts off the discussion by describing his typical patient population that requires stenting. Patients usually present to the clinic experiencing headaches, vision issues, and pulsatile tinnitus. Typically, these patients are female and overweight, and have been referred from headache clinics, neurosurgeons, and ENT specialists. Around 50% of his patients arrive with prior diagnoses and a complete workup already done, and they only require the procedure to be done. For the remaining patients, Aaron starts from scratch, emphasizing meticulous preparation imaging, which includes MRV with contrast. Aaron has a sequential approach for outpatients. He typically conducts diagnostic and treatment processes separately, to ensure that no complicating fistulas are present during interventions. Three months after the procedure, patients are referred for follow-ups with ophthalmologists to verify progress. During the procedure, Aaron starts with a diagnostic angiogram from the groin. During this time, he also obtains pressure measurements using a 27 mm diagnostic microcatheter. He typically measures from superior central sinus and then works his way back. He then obtains an MR venogram, which typically shows bilateral transverse sinus stenosis, and he measures pressure on both sides of the sinus. For him, a significant enough gradient to stent is typically 10 mmHg, however clinical presentation remains a key factor in deciding to stent patients with a lesser gradient. For the treatment procedure, patients are prescribed 75 mg Plavix and baby aspirin for five days before the intervention. On the day of the procedure, general anesthesia is administered, due to its neck-based approach. This approach not only provides better maneuverability, but also avoids complications associated with the heart, given the complexities of navigating the transverse sinus junction. Stent sizing remains highly personalized and tailored to the size of the patient's sinus, with no rigid guidelines in place. Patients typically stay overnight, with clear communication regarding the likelihood of experiencing a headache post-treatment. Following the procedure, they adhere to a six-month regimen of the dual antiplatelet therapy, which improves their recovery and treatment outcomes.

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Ep. 43 Managing Urosepsis with Dr. Caire and Dr. Bennett

Ep. 43 Managing Urosepsis with Dr. Caire and Dr. Bennett

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/rn9T7J Urologist Dr. Arthur Caire and IR Dr. Shelby Bennett return to the BackTable Podcast to discuss their approaches to urosepsis, stent vs. nephrostomy for a variety of presentations, and the middle-of-the-night patient.

2 Juni 201934min

Ep. 42 Physician Contract Negotiation with Dr. Mary Costantino and Courtney Angeli

Ep. 42 Physician Contract Negotiation with Dr. Mary Costantino and Courtney Angeli

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/igMUV3 Dr. Mary Costantino and her contract lawyer Courtney Angeli discuss the essentials of physician contract negotiation: finding the right lawyer, partnerships, non-competes, and critical pitfalls to avoid.

12 Maj 20191h

Ep. 41 IR and Urology Collaboration on Renal Masses with Dr. Caire and Dr. Bennett

Ep. 41 IR and Urology Collaboration on Renal Masses with Dr. Caire and Dr. Bennett

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/PZalEv Urologist Dr. Arthur Caire and IR Dr. Shelby Bennett discuss their approaches to treating renal masses, including ways in which IR and Urology collaborate, laparoscopic versus percutaneous ablation, follow-up imaging, and more.

29 Apr 201939min

Ep. 40 Treating the Difficult IV Access (DiVA) patient with Dr. Chick and Dr. Jagannathan

Ep. 40 Treating the Difficult IV Access (DiVA) patient with Dr. Chick and Dr. Jagannathan

Dr. Arun Jagannathan and Dr. Jeffrey Chick discuss their approach to the Difficult IV access (DiVA) patient. Special thanks to sponsor Access Vascular Inc. for lending their booth at #SIR19ATX.

26 Mars 201917min

Ep. 39 Better Biopsies With Dr. Thor Johnson

Ep. 39 Better Biopsies With Dr. Thor Johnson

Dr. Thor Johnson discusses his experience with the Argon BioPince biopsy needle for liver, renal and soft tissue biopsies, including tips and tricks for obtaining better biopsy samples with fewer passes. Recorded at SIR 2019 in ATX.

25 Mars 201912min

Ep. 38 Special guest Physician on Fire (POF) talks financial independence for physicians

Ep. 38 Special guest Physician on Fire (POF) talks financial independence for physicians

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/GfYFHp Physician on FIRE (PoF) founder Dr. Leif Dahleen discusses financial independence for physicians. Leif created his platform to inform and inspire physicians with insightful writing after he attained financial independence and the freedom to retire early. More information at physicianonfire.com

20 Feb 201951min

Ep. 37 Treating PAD in the OBL with Dr. Mike Watts and Dr. Omar Saleh

Ep. 37 Treating PAD in the OBL with Dr. Mike Watts and Dr. Omar Saleh

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/9HpSIv Special guests Dr. Mike Watts and Dr. Omar Saleh discussing the ins and outs of treating PAD in the Outpatient Based Lab (OBL) setting. Includes great info on practice building, patient safety, and essential equipment. #irad #miips

7 Jan 201957min

Ep. 36 Building the UFE and OBL practice with Dr. Mary Costantino

Ep. 36 Building the UFE and OBL practice with Dr. Mary Costantino

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/HRWoTs Dr. Mary Costantino tells us the story of how she built her OBL practice in Portland and discusses the advantages of performing UFE and other procedures in the outpatient setting.

19 Dec 201852min

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