Pulsatile Tinnitus
Conditions
Keywords
Dural arteriovenous fistulae, Pulsatile tinnitus, Venous Stenting
Brief summary
The goal of this randomized trial to assess the angiographic efficacy of venous stenting in dural arteriovenous fistulae (DAVF) via improvment on Cognard's Classification as compared to no intervention at 6 months Participants belonging to experimental group will be treated using venous stenting. DAVF will be assessed by angiography at 6 months follow-up. Participants belonging to control group will be followed accordingly to standard of care (no treatment). After 6 months, control group patients can be treated by any means accordinlgly to standard of care.
Detailed description
DAVF are frequently revealed as a cause of invalidating pulsatile tinnitus (PT). Endovascular treatment (EVT) of DAVF using liquid embolic agent (LEA) is currently performed when an hemorrhagic risk of intracranial hemorrhage is identified (high grade DAVF). PT alone may not be a sufficient condition to offer EVT because procedure-related risks may overcome clinical benefits specifically in case of extended shunts requiring complex procedures. Stenting of dural sinus may represent an alternative to LEA-EVT with a simple and low risk procedure. Thus PT could be cured even in case of low grade DAVF without neurologic risk.
Interventions
DEVICEVenous stenting
venous stenting associated to antiaggregation protocol
OTHERStandard of care
observation: no treatment
Sponsors
French Ministry of Social Affairs and Health
University Hospital, Bordeaux
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patient presenting invalidating pulsatile tinnitus * Patient presenting with PT anatomically correlated with a DAVF * Type I or IIa DAVF on digital subtraction angiography (DSA), according to Cognard's classification. * DAVF located on sigmoid , lateral or posterior longitudinal sinus. * Fistula length compatible with use of up to two stents * Highly effective contraception for women of childbearing potential, maintained during research procedures * Affiliated or beneficiary of health insurance * Signed informed consent
Exclusion criteria
* Patient with DAVF not eligible for endovascular treatment . * DAVF classification of IIb or more according to Cognard's classification. * DAVF with severe sinus stenosis or occlusion judged as nor eligible for sinus stenting. * DAVF showing evidence of recent (inferior to 3 months) thrombophlebitis at the site of fistulous dural sinus. * Patient with DAVF previously treated with surgery or radiotherapy. * Patient with multiple DAVF * Controlateral sinus aplasia or occlusion * Patient presenting contra-indication to the use of LEA according to the instructions For Use. * Patient participating in another clinical study evaluating another medical device, * Any condition or any situation that would prohibit the patient from coming to the investigational center for the follow-up as recommended by the study protocol at 6 months. * Patient with any known allergy to heparin, acetylsalicylic acid, Coumadin , Warfarin or other antiplatelet medications * Patient has undergone a surgery including endovascular procedures in the last 30 days prior to the study procedure. * Patient has had an Intracranial hemorrhage and/or subarachnoid hemorrhage in the past 30 days prior to the study procedure * Known serious sensitivity to radiographic contrast agents. * Known sensitivity to nickel, titanium metals, or their alloys * Known renal failure as defined by a serum creatinine \> 2.5 mg/dl (or 220 μmol/l) or glomerular filtration rate (GFR) \< 30. * Patient who has a contraindication to MRI or angiography for whatever reason * Women who are pregnant, lactating, or who are planning to become pregnant during the anticipated study period * Patient unable to understand the nature, risks, significance and implications of the clinical investigation or unwilling to provide written informed consent * Patient under legal protection
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cognard's classification grade | Month 6 | Cognard's classification status : from type I (Anterograde drainage into venous sinus) to Type V (Drainage into the spinal perimedullary veins) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Headaches | Baseline, Month 6 | Assessment via Visual Analog Scale from 0-no trouble to 10-extreme troubles |
| Dizziness | Baseline, Month 6, Month 12, Month 24 | Assessment via Visual Analog Scale from 0-no trouble to 10-extreme troubles |
| THI score | Baseline, Month 6, Month 12, Month 24 | THI (Tinnitus Handicap Inventory) score (based on 100 points scale from Grade 1 (\<16 points) Slight or no handicap to Grade 5 (\>=78 points) Catastrophic handicap) |
| Sleep troubles | Baseline, Month 6, Month 12, Month 24 | Assessment via Visual Analog Scale from 0-no trouble to 10-extreme troubles |
| Rate of stent thrombosis | Month 6, Month 12, Month 24 | Rate of stent thrombosis |
| unsuccessful stent deployment | Baseline | Rate of unsuccessful stent deployment |
| Concentration troubles | Baseline, Month 6, Month 12, Month 24 | Assessment via Visual Analog Scale from 0-no trouble to 10-extreme troubles |
| modified Rankin Scale | Baseline, Month 6 | mRS Neurological score (from 0 - No symptoms at all to 6 - Death) |
Countries
France
Contacts
Primary ContactXavier BARREAU, MD
Outcome results
None listed