2025 American Academy of Neurology Abstract Website

Objective:

To determine long-term benefit and safety of venous sinus stenting (VSS) in idiopathic intracranial hypertension (IIH).

Background:

IIH is a condition affecting young individuals, predominantly women. Multiple studies have shown that VSS is effective in treating IIH-associated papilledema, but long-term outcomes are not well described.

Design/Methods:

A single center retrospective chart review was performed for patients with IIH who underwent VSS between May 2015 and October 2021 with >36 months of follow-up. Data were collected pre-VSS and from two time points representing short and long duration measures: (1) within the first 12 months post-VSS, and (2) >36 months post-VSS. We evaluated the presence of headache, pulse-synchronous tinnitus, IIH-related medications, and need for additional procedures. Neuro-ophthalmic exam and testing including optical coherence tomography and visual fields were reviewed for patients at all three time points. VSS-related complications were also noted.

Results:

Of 81 patients who underwent VSS, 38 (47%) had >36 months follow-up. Median follow-up was 53 months (IQR 46-61). Median papilledema grade pre-VSS was 1 (IQR 0.3-3) with 25 patients (66%) having grade 1 papilledema or worse. At the most recent visit, median papilledema grade was 0 (IQR 0-0.5) and 22 patients (58%) were off all IIH medications. Ten patients (26%) underwent additional procedures after initial VSS, including repeat VSS, bariatric surgery, or ventriculoperitoneal shunt placement for any indication. Four patients (11%) underwent additional procedures for persistent or worsening papilledema. Complications within the first 12 months post-VSS were seen in 3 patients (8%) including pain, post-operative seizure, and femoral hematoma. A single patient (3%) had delayed stent thrombosis (non-occlusive), but no other delayed complications were noted in the cohort.

Conclusions:

This study offers longitudinal post-VSS follow-up on a relatively large IIH patient cohort. It echoes the findings of earlier smaller studies that VSS can offer a safe treatment option with sustained long-term benefit.