Has anyone had a jugular stent?

Hello Everyone,

I have been lurking on the sidelines of this site for over two years during my Vascular Eagle Syndrome diagnosis, my left side styloidectomy, and 1-year post-op. I finally decided to make an account and join the community. This site has been a wealth of knowledge and anecdotal experiences for me to better understand this condition, so THANK YOU ALL!

I had my left styloid removed April 2023 by Dr. Hepworth after I was diagnosed with bilateral jugular vein compression. Dr. Hepworth’s theory was my sternocleidomastoid muscles along with my styloids were the cause of my compression based on CT and ultrasound results. He chose to operate on my left side because my symptoms were greater on the left side of my body which included nerve pain in my left shoulder and collarbone and nausea/dizziness when turning my neck left. I also had intercranial hypertension, insomnia, extreme tightening of my neck muscles, and muscle spasms among other symptoms. My dominant jugular vein is on the right, but I do not have any nerve pain or problems when turning on that side.

I felt a lot of relief right after the surgery with most of my symptoms disappearing. However, about a 1-2 months after surgery my symptoms came back. Dr. Hepworth believed it to be caused by swelling from the surgery at first, but by October my symptoms still had not resolved so he order another ultrasound which revealed that my left jugular had closed. He has referred me to Dr. Fargen in North Carolina to get a venogram and evaluation for a stent.

My appointment with Dr. Fargen should be in May (still getting things lined up). My understanding is that after the venogram, Dr. Fargen will decide if he thinks I need a stent or not, and if I choose to I could have it placed within the same week I am there.

Has anyone on this site had a stent placed in their jugulars? If so what was your experience?

From what Dr. Fargen’s nurse told me, he has the most experience with Jugular vein stents and has placed about 60 of them. They said the most common symptom is nerve pain in your neck and arm, but that usually doesn’t happen if the styloid has been removed already.

At almost 1-year post op from my styloidectomy, the nerve pain I was experiencing in my left shoulder/neck is about 90% gone and the nausea I used to feel when turning my head left is completely gone. However, my insomnia, intercranial hypertension, and tightness of my neck muscles/ neck spasms, are only about 50% improved.

Just trying to collect as much data as I can before seeing Fargen in May, since it seems jugular stents are not done very often and the risks involved. Thank you in advance for your input!

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@chbugo - Welcome to our forum! I’m really glad you’ve found good information here that helped you make decisions about how to move forward with your treatment for vES/vascular outflow obstruction. I’m really sorry that your IJV re-collapsed after your surgery. We have a few members who’ve had that problem. I’m not sure how many have had stents placed so I can’t give you a helpful answer there. I expect someone will reply to share his/her experience though. While you wait, you can do some searching for posts by clicking on the magnifying glass image in the upper right corner of this page. Try searching “stent or stents” &/or Dr. Fargen as his name comes up on here from time to time. Our member @PatientD may be a good resource for you, too.

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Try to stretch and strengthen your SCM, digastric, scalene, levator scapula, trapezoids, rhomboids and other neck/shoulder/back muscles before getting the stent and see if that helps or not, as stents is irreversible solution, and it sometimes helps, sometimes doesn’t or even makes it worse.

This long one-liner might sound very direct and “vague” (“every doctor said that until I found the surgeon who knows about Eagle’s syndrome”), but has very substantial foundation.

Though be very careful with the remaining styloid, as it may injure your arteries/veins.

Personally I’d get the second styloid removed first before getting the stent. But that’s just my personal non-professional opinion.

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I’ve heard Dr Hackman once mention something about Dr Fargan using a retrievable stent. I really don’t know what that means but it’s something to ask about. The big issue with a stent is either migration or if there isn’t enough room between the c1 lateral mass and the compressing muscles.

I’ve seen stents go both ways for people, both very positive and some really negative. Not trying to scare you but I’d make sure to have an in depth discussion with Dr Fargan about the possible side effects of a stent and if perhaps a c1 shave or muscle resection is the safer option.

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I do agree with what the others have suggested; to be cautious and explore other options before having a stent. If your SCM is also causing compression then that would potentially be easier to get sorted rather than a permanent stent maybe? If you’re still having extremely tight muscles and this is what’s possibly causing the compression and collapse of the IJV, then I don’t know if a stent is fitted if this could be potentially painful for you?
And I agree with @vdm that getting your other side styloid removed might be an idea next, especially if the side remaining is your dominant IJV. I was lucky and just having the styloid removed was enough to re-open the IJV and ease the IH symptoms, I opted to have the other side removed too as although less symptomatic it was still compressing my IJV and having that second surgery improved symptoms even more, so might be worth considering?

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Hello, sorry to hear your health issues. I have heard that stents inside skull have very good/reliable outcomes for patients. But in neck areas we move all the time and so stents in neck can be more problematic. But I do not have any stents myself and Dr Hackman is highly regarded.

On muscle tension in SCm I have been using dry needling. It is painful but it is effective at forcing muscle to relax. Medic prescribed me muscle relaxant too but I have yet to try that. Medics do inject Botox in to trapezius muscles to try & relax them but I am not sure if they do that for other muscle groups. I have tried stretching but with limited success.

Good luck with your treatment. Take care. D

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That’s interesting. I always thought that any stent eventually gets surrounded/“wrapped” by the body’s connective or whatever type of tissue, as it’s a foreign object and the immune system tries to isolate it… Perhaps it’s time to update my knowledge.

Upd: so I found something about “retrievable stents”, but perhaps it’s not exactly what Dr Hackman had mentioned?

These stents are a fine metallic mesh that is navigated into the area of blood clot, then “catches” the clot and is retrieved back together with the clot, not left inside the body.

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Isaiah, vdm, elijah, Jules, and PatientD-- Thank you for all of your helpful words of advice and suggestions. I agree that I should be cautious about getting a stent. My partner and I decided that I will pause on getting the stent if Dr. Fargon suggests it–which my appointment with him is now the 1st week of April. We have a big move coming up in May/June and I wouldn’t feel comfortable lifting furniture right after a stent placement. So I will just have the evaluation done for now.

I think I misrepresented the condition of my left jugular post surgery in my previous comment. It had been a while since I looked at the post-styloidectomy ultrasound results and I sort of chocked it up as my jugular closed. However, it is a bit more complicated. I just reviewed the ultrasound results and it indicates:

  • The pulse velocities in my left jugular decreased significantly at the sternocleidomastoid post surgery, but there is a significant increase on the left side at the jugular foreman and base of the neck.

  • The pulse velocities in my right jugular decreased in the lower neck though remained elevated post styloidectomy and became elevated in the upper neck (pre-styloidectomy the upper neck was normal).

  • The ultrasound report stated that “no stenosis was detected maybe due to technique or more proximal stenosis in the head”

So I believe Hepworth needs Fargen to evaluate my neck jugulars and the sinuses in my skull?

Regarding my muscle tightness, you all have reminded me to keep stretching them, so thank you! :smiley:

PatientD, I will keep dry needling and botox injections in mind to ask about in my upcoming appointments. I am currently prescribed cyclobenzaprine, which helps relax my neck muscles and helps with my insomnia.

vdm, I’ll try to remember to ask Fargen what he knows about retrievable stents. Very cool video!

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I hope that your move goes well, and let us know how you are going forward :hugs:

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@chbugo - It sounds like you have a good plan in place regarding postponing the stent surgery but continuing w/ the consult as planned. Please let us know what Dr. Fargen says as we’re here to support you however you need.

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