Introduction/Purpose Idiopathic intracranial hypertension (IIH) is a debilitating disorder with headaches and visual complaints as the most prevalent clinical symptoms. Treatment of venous outflow obstruction due to venous sinus stenosis has moved into focus in the past years. For venous sinus stenting, there is currently no consensus on the type of stent, dedicated venous stent or ‘off-label’ carotid stent, and the degree of radial force it should possess. We suggest that the use of a low-profile, low radial force carotid stent is a safe and effective option for venous sinus stenting with low rate of complications and in-stent intimal hyperplasia formation.

Materials and Methods We retrospectively reviewed our neurointerventional database between July 2019 and March 2023 and identified all patients who underwent venous sinus stenting for treatment of medically refractory IIH. Patient characteristics, procedural details as well as imaging and clinical outcomes were collected.

Results A total of 10 patients (9 females) underwent venous sinus stenting. All patients had an established diagnosis of IIH and failed medical management. Bilateral stenting was performed in 2 patients in a staged fashion. Mean patient age was 37 years (range 29-42 years). Venous sinus stenoses were seen on the right transverse-sigmoid sinus in 8 cases and on the left in 4 cases. Most stenoses (n=9) were severe (≥70% stenosis). Mean pressure gradient across the stenotic venous sinus segment was 14 cm of water (range 7 - 24 cm of water). The Carotid Wallstent was used in most cases (n=11). One case required telescopic placement of 2 Wallstents. Stents were successfully delivered in all cases. No device related complications occurred. Patients were initiated and maintained on dual antiplatelet therapy with either aspirin 81 mg and plavix 75 mg daily or aspirin 81 mg and ticagrelor 90 mg BID. Patients requiring anticoagulation were maintained on single antiplatelet agent, either plavix or ticagrelor, in addition to the anticoagulation. One patient experienced a post-procedure deep venous thrombosis in the leg used for venous access during the procedure. Nine clinical follow-ups were available, and one patient is due to be seen in the next 2-3 months. All patients reported marked improvement of their symptoms if not complete resolution. Six-month angiogram follow-up was available in 5 patients (50%) showing a patent stent in all cases. Four follow-ups are scheduled in the next 2-4 months. Two patients had a 12-months follow up which shoed persistent patency of the stent in both cases.

Conclusion Use of a low profile, low radial force carotid stent for treatment of sinus venous stenoses in IIH patients resulted in excellent technical and clinical outcomes. Short-term follow-up shows maintained stent patency without intimal hyperplasia.

Disclosures A. Kuhn: None. A. Puri: 1; C; NIH, Microvention, Cerenovus, Medtronic Neurovascular and Stryker Neurovascular. 2; C; Medtronic Neurovascular, Stryker Neurovascular, Balt, Q’Apel Medical, Cerenovus, Microvention, Imperative Care, Agile, Merit, CereVasc, Arsenal Medical. 4; C; InNeuroCo, Agile, Perfuze, Galaxy and NTI.. S. Sarid: None. M. Garcia: None. J. Singh: None.