Table 3

Summary of recommendations

Category	Recommendations	Score
Patient selection for diagnostic catheter angiography
Imaging based selection	It is reasonable to use non-invasive venous imaging as a screening tool to determine candidacy It is reasonable to suggest that IIH patients without previous imaging studies or with studies demonstrating no evidence of sinus stenosis undergo diagnostic venography regardless	Moderate Weak
Medically refractory symptoms	It is reasonable to perform diagnostic catheter angiography on patients who continue to have symptoms while on medical therapy or who are intolerant of medical therapy	Moderate
Intracranial pressure	It is reasonable to perform venography on patients with intracranial pressures greater than 25 cm H₂O It is reasonable to perform venography on patients in select cases where pressures are below 25 cm H₂O	Moderate Weak
Body Mass Index	BMI should not be used to influence candidacy for diagnostic catheter angiography	Weak
Angiography procedural considerations
Manometry	Venography should be performed to assess candidacy for treatment prior to stenting A pressure gradient of 8 mmHg or higher should be present when selecting candidacy for stenting A pressure gradient threshold of 4–7 mmHg may show benefit in select cases	Strong Moderate Weak
Arteriography	It is reasonable to perform selective catheter arteriography in conjunction with venography and manometry to evaluate venous anatomy and outflow patterns	Moderate
Anesthesia choice	Diagnostic venography and manometry should be performed with the patient awake.	Moderate
Microcatheter	A large diameter microcatheter is recommended, or a smaller diameter catheter which is shown to be more accurate in the literature such as the Echelon 10 or Prowler Select Plus	Weak
Stenting procedural considerations
Stent	There are no data to suggest superiority or inferiority of different stent devices in venous sinus stenting	Weak
Unilateral vs bilateral stenting	There are no data to support a benefit to upfront bilateral transverse sinus stenting over unilateral stenting	Weak
Number of stents	There are no data to suggest the use of multiple stents to reduce the risk of retreatment or treatment failure	Weak
Antiplatelet agents	Antiplatelet agents should be administered prior to stenting and in the follow-up period for at least 3–6 months following stenting There are no data to support inferiority of single antiplatelet agents over dual antiplatelet agents, although thromboembolic complications have been reported with aspirin use only	Strong Weak
Post-stent manometry	Post-stenting manometry should be performed to confirm resolution of the pressure gradient after stenting to document procedural success	Strong
Consideration of retreatment
	It is reasonable to repeat angiography and manometry on patients with recurrence of symptoms after resolution with stenting to evaluate for recurrent stenosis	Strong