Introduction/Purpose Venous sinus stenting (VSS) has recently emerged as a leading intervention in patients presenting with idiopathic intracranial hypertension (IIH). Long-term follow-up data on this intervention is sparse, with more recent data reporting as high as 70% chance of symptom recurrence or no improvement post-VSS, most commonly being pressure headaches and pulsatile tinnitus. Despite this, improvement in papilledema remains as a consistent attribute to VSS. This discrepancy between papilledema improvement alongside poor symptomatic outcomes encourages further exploration into the factors that play the largest role in treatment success, and is necessary for future enhancements of candidacy criteria in VSS.

Materials and Methods This study included patients who underwent VSS for IIH and had pre-VSS and post-VSS ophthalmological records via Frisen Grading scale and outcome data in the form of WHO-BREF QoL and HIT-6 Headache scores.

Results 83 patients met the study criteria, and 51 (61.4%) reported the presence of pre-procedural papilledema. Mean HIT-6 and WHO-BREF QoL scores pre-procedure were 63.5 (10.2) and 62.3 (17.1), respectively. When controlling for BMI, age, race, and sex, pre-procedure HIT-6 scores were predictive of WHO-BREF QoL scores (p = 0.03). Analysis of HIT-6 scores and WHO-BREF QoL scores taken pre-procedure demonstrated no significant difference between those with papilledema pre-VSS and those without (p = 0.73). Of the 51 patients with pre-VSS papilledema, 39 (76.5%) demonstrated significant improvement in papilledema post-VSS. Improvement in papilledema was not associated with either positive or negative changes in WHO-BREF QoL or HIT-6 scores post-procedure (p = 0.96, p = 0.46).

Conclusion These observations challenge the traditional emphasis on papilledema as a primary metric for assessing the severity and improvement of IIH symptoms following VSS. While papilledema improvement post-VSS remains significant, it does not appear to correlate with changes in patient-reported outcomes. The incorporation of additional measures, particularly those from the patient’s perspective, are encouraged in future interventions, as such data may be useful in establishing clearer guidelines for VSS candidacy.

Disclosures J. Midtlien: None. N. Kiritsis: None. C. Kittel: None. K. Fargen: None.