Influence of clinical, anatomical, and manometric factors on unilateral transverse sinus stent placement for idiopathic intracranial hypertension

OBJECTIVE: Venous sinus stent placement is an increasingly common endovascular technique for treating medically refractory symptoms related to idiopathic intracranial hypertension (IIH). Given that data suggest that a considerable number of patients experience symptom relapse or recurrence, understanding prognosticators of treatment failure is of particular interest. METHODS: The authors performed a single-center retrospective review of the medical records of surgically naive patients with IIH who underwent unilateral transverse sinus stent (TSS) placement. Pre-stent clinical, anatomical, and manometric variables were evaluated against post-stent outcomes to determine significant predictors of unfavorable outcomes after treatment. RESULTS: Forty-two surgically naive patients with IIH underwent unilateral TSS insertion between April 2011 and February 2024. At a mean follow-up of 41 months, 47.6% had ongoing symptoms, 38.1% received escalated medical therapy, 23.8% underwent stent restenosis, and 23.8% underwent procedural retreatment. Younger age at the time of initial stent insertion was associated with post-stent operative retreatment (OR 1.15, p = 0.04), while lower pre-stent BMI predicted resolution of papilledema (OR 0.84, p = 0.003). Higher pre-stent BMI and lower pre-stent pressure gradients were associated with several unfavorable outcomes. CONCLUSIONS: Modifiable and unmodifiable risk factors may impact TSS durability for IIH. Larger multicenter studies are warranted to stratify risk for futile TSS outcomes and characterize the ideal IIH candidate for therapy.