Phantom limbs and related phenomena in recent traumatic amputations

Abstract

Introduction Venous sinus stenting (VSS) has emerged as an alternative treatment for idiopathic intracranial hypertension (IIH) patients with evidence of transverse-sigmoid stenosis and symptoms refractory to medical therapy. Though its efficacy in alleviating visual deficits, papilledema, headache and nausea is promising, a substantial rate of restenosis can occur either within or adjacent to the stented segment. It is possible that increase of, or failure to lose, body-weight could potentially be a mechanism behind restenosis, as central venous pressure would remain elevated. We report IIH patients who underwent VSS at our institution and compare characteristics between those with and without restenosis, focusing on patient’s body mass index (BMI). Methods Our institution’s database was retrospectively analyzed. We included all IIH patients who underwent VSS between January 2021 March 2022. Analysis between restenosis and non-restenosis groups was performed. Body mass index was evaluated as a continuous variable and also as categorical by stratification into normal (<25), overweight (25–29.9), obesity class I (30–34.9), obesity class II (35–39.9), obesity class III (≥40). BMI groups were dichotomized into normal or mildly obese (normal, overweight and obesity class I) and moderate to severely obese (obesity classes II and III). Results A total of 55 patients were included, of which 7 (12.7%) had restenosis. Age, sex, and comorbidities were similar between non-restenosis and restenosis patients. Opening pressure on lumbar puncture was similar between the groups (non-restenosis, 35.1 vs restenosis, 38.1, P=0.304). Median BMI at time of procedure was similar between the groups (non-restenosis, 35.1 vs non-restenosis, 37.1, P=0.958). Median pre-stenting pressure gradient was not significantly different between the groups (non-restenosis, 17 vs restenosis, 21, P=0.280), and neither was immediate post-stenting pressure gradient (non-restenosis, 1 vs restenosis, 3, P=0.230). Median time of follow-up was not significantly different between the groups (non-restenosis, 676 days vs restenosis, 597 days, P=0.319). Median BMI at last follow-up or at date of restenosis detection was not significantly different between the groups (non-restenosis, 36.1 vs restenosis, 36.5, P=0.904). Neither stratification nor dichotomization of BMI revealed differences between the groups. Median BMI change from procedure to last follow-up was not different between the groups (non-restenosis, 0.1 vs restenosis, 0, P=0.552). Reduction in BMI class was also not different between the groups (non-restenosis, 12.5% vs restenosis, 28.6%, P=0.645). Conclusions Idiopathic intracranial hypertension patients with venous sinus stenosis treated with VSS who had restenosis were similar to those who did not with regards to demographics, pressure gradients and duration of follow-up. Body mass index did not predict restenosis as we hypothesized. Disclosures J. Cappuzzo: None. A. Monteiro: None. N. Siddiqi: None. A. Baig: None. W. Khawar: None. B. Donnelly: None. S. Housley: None. M. Waqas: None. E. Levy: 2; C; Claret Medical, GLG Consulting, Guidepoint Global, Imperial Care, Medtronic, Rebound, StimMed, Misionix, Mosiac, Clarion, IRRAS. 4; C; NeXtGen Biologics, RAPID Medical, Claret Medical, Cognition Medical, Imperative Care, Rebound Therapeutics, StimMed, Three Rivers Medical. A. Siddiqui: 2; C; Amnis Therapeutics, Apellis Pharmaceuticals, Inc., Boston Scientific, Canon Medical Systems USA, Inc., Cardinal Health 200, LLC, Cerebrotech Medical Systems, Inc., Cerenovus, Cerevatech Medical, Inc.,. 4; C; Adona Medical, Inc., Amnis Therapeutics, Bend IT Technologies, Ltd., BlinkTBI, Inc, Buffalo Technology Partners, Inc., Cardinal Consultants, LLC, Cerebrotech Medical Systems, Inc, Cerevatech Medical.