Medically refractive IIH patients can benefit from venous sinus stenting

This prospective pilot study assessed the efficacy of venous sinus stenting in patients with idiopathic intracranial hypertension (IIH).

Study design

Investigators prospectively followed 10 patients for whom medical therapy for venous sinus stenosis associated with IIH had failed. All patients were offered venous sinus stenting if they met the following criteria: confirmed diagnosis of IIH, significant pressure gradient across a venous sinus stenosis and elevated intracranial pressure (ICP).

Outcomes

Following stent placement, all patients had resolution of their stenosis and pressure gradients. ICP values showed an immediate decrease, and all patients demonstrated subjective and objective improvements. 

Two patients developed stent-adjacent stenosis. Retreatment abolished the stenosis and gradient in both cases. 

The 7 patients who presented with papilledema had resolution on follow-up fundoscopic imaging and optical coherence tomography, as well as improvement on visual field testing. 

Limitations

Although the findings are promising, a larger cohort with additional follow-up is necessary to determine long-term outcomes.

Clinical significance

This study adds to the growing peer-reviewed literature supporting the use of venous sinus stenting in patients with elevated ICP who failed medical therapy. 

The authors conclude that venous sinus stenting was beneficial in select patients with IIH who had venous sinus stenosis with an elevated pressure gradient and ICP. The procedure resulted in resolution of venous pressure gradient and reduction in ICP. Functional, neurological and ophthalmological improvements were also noted.