{
  "abstract": "Introduction Normal pressure hydrocephalus (NPH) is a neurological condition typically managed by cerebrospinal fluid diversion through open surgical ventriculoperitoneal shunt placement. Endovascular shunting from the cerebellpontine angle cistern to the internal jugular vein has recently demonstrated encouraging safety and efficacy data through 90-day follow-up, suggesting a role as an alternative treatment for the disease. We report continued follow-up through 180-days in participants with NPH from a prospective, multicenter, single-arm trial of this novel device.Methods The NPH triad of gait disturbance, cognitive impairment, and urinary incontinence was evaluated at baseline and 180-day follow-up using standardized metrics: Timed Up & Go (TUG) test for gait, Montreal Cognitive Assessment (MoCA) for cognition, and Neurogenic Bladder Symptom Score-Short Form (NBSS-SF) for urinary function. Patients with ≥20% TUG improvement after screening lumbar CSF withdrawal, opening pressure ≥8 cm H 2O, and favorable anatomy on pre-operative brain MRI and CT imaging were included. Adverse events through 180 days were documented and adjudicated by an independent data monitoring committee. Imaging was assessed by independent imaging core lab.Results In sixty-six treated participants (21 female; mean 75.4 +/- 5.0 years), two procedure-related SAEs (3.0%; 2/66) occurred through 180-day follow-up. These included one sigmoid sinus thrombosis and one femoral artery pseudoaneurysm, both resolving without surgical intervention. There were no instances of cerebral hemorrhage, over-drainage, infection, device-related serious adverse events (SAE), or device- or procedure-related deaths in any participant. The absence of radiologic signs of hemorrhage and over-drainage were confirmed by the independent imaging core lab assessment. Sixty participants completed 180-day efficacy assessments, with fifty-nine (98.3%) exhibiting post-operative improvement in at least one NPH symptom compared to baseline. Matched-pair analysis identified statistically significant mean improvements in each of the three symptom metrics, with improved TUG time (30.5%; p<0.0001), improved MoCA score (+1.6 points; p<0.001), and improved NBSS-SF score (-2.0 points; p<0.01). 78% of participants exhibited TUG improvement at the 180-day follow-up visit that exceeded the established minimal clinically important difference of ≥16.5% compared to baseline. One participant (1.5%; 1/66) received subsequent ventriculoperitoneal shunt placement within the 180-day follow-up period after presenting with 18% regression in TUG time.Conclusions Endovascular shunting was feasible with a low SAE rate and clinically meaningful improvement in NPH symptoms through 180 day follow-up. These findings support further investigation of endovascular shunting as an NPH treatment option in an ongoing randomized controlled trial compared with a ventriculoperitoneal shunt arm (STRIDE; NCT06498960).Disclosures P. Lylyk: None. C. Matouk: 4; C; CereVasc. R. Hanel: None. J. Reavey-Cantwell: None. H. Riina: None. D. Altschul: None. A. Siddiqui: None. J. Fraser: None. K. Ebersole: None. T. Bhalla: None. M. Bender: None. C. Ogilvy: None. P. Taussky: None. A. Baker: None. M. Jayaraman: None. C. Heilman: 2; C; CereVasc. 4; C; CereVasc. A. Malek: 2; C; CereVasc. 4; C; CereVasc.",
  "authors": [
    {
      "affiliations": [
        "ENERI, CABA, Argentina"
      ],
      "name": "P Lylyk"
    },
    {
      "affiliations": [
        "Yale University Medical Center, New Haven, CT"
      ],
      "name": "C Matouk"
    },
    {
      "affiliations": [
        "Lyerly Neurosurgery, Jacksonville, FL"
      ],
      "name": "R Hanel"
    },
    {
      "affiliations": [
        "Neurosurgery, Virginia Commonwealth University Medical Center, Richmond, VA"
      ],
      "name": "J Reavey-Cantwell"
    },
    {
      "affiliations": [
        "NYU Medical Center, New York, NY"
      ],
      "name": "H Riina"
    },
    {
      "affiliations": [
        "Montefiore Medical Center, Bronx, NY"
      ],
      "name": "D Altschul"
    },
    {
      "affiliations": [
        "University of Buffalo, Buffalo, NY"
      ],
      "name": "A Siddiqui"
    },
    {
      "affiliations": [
        "Neurological Surgery, University of Kentucky, Lexington, KY"
      ],
      "name": "J Fraser"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Kansas, Kansas City, MO"
      ],
      "name": "K Ebersole"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Rochester Medical Center, Rochester, NY"
      ],
      "name": "T Bhalla"
    },
    {
      "affiliations": [
        "University of Rochester Medical Center, Rochester, NY"
      ],
      "name": "M Bender"
    },
    {
      "affiliations": [
        "Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA"
      ],
      "name": "C Ogilvy"
    },
    {
      "affiliations": [
        "Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA"
      ],
      "name": "P Taussky"
    },
    {
      "affiliations": [
        "Neurosurgery, Montefiore Medical Center, Bronx, NY"
      ],
      "name": "A Baker"
    },
    {
      "affiliations": [
        "Rhode Island Hospital, Providence, RI"
      ],
      "name": "M Jayaraman"
    },
    {
      "affiliations": [
        "Neurosurgery, Tufts Medical Cetner, Boston, MA"
      ],
      "name": "C Heilman"
    },
    {
      "affiliations": [
        "Neurosurgery, Tufts Medical Center, Boston, MA"
      ],
      "name": "A Malek"
    }
  ],
  "title": "O-052 180-day follow-up after endovascular shunt treatment for normal pressure hydrocephalus",
  "uid": "28f24c97-eaa4-5987-b10c-1011c3991099"
}