Venous sinus stenting for idiopathic intracranial hypertension in the MENA region: initial results from the VEHICLE Registry.

Abstract

Objective: To evaluate the clinical outcomes and safety of venous sinus stenting in idiopathic intracranial hypertension (IIH) patients across multiple centers in the Middle East and North Africa (MENA) region through the Venous stEnt for idiopathic intraCranial hypertEnsion (VEHICLE) Registry.

Methods: We conducted a retrospective analysis of prospectively collected data from the VEHICLE Registry (NCT06692790) between August 2023 and August 2024. From an initial pool of 187 cases, 100 patients met all inclusion criteria: IIH diagnosis based on modified Dandy criteria, neuroimaging-confirmed venous sinus stenosis, refractory or intolerant to medical therapy, underwent venous pressure manometry, and had complete follow-up data. All patients underwent venous sinus stenting at nine collaborating centers.

Results: Of 100 patients, 73% were female. All presented with headaches, while 87% reported visual disturbances. Venous stenoses predominantly affected the right transverse sinus (56%). At six months, 83% achieved marked symptom resolution, 80% had normalized optic nerve heads, and stent patency was confirmed in 90%. Papilledema grades improved significantly from median Grade III at baseline to Grade I at 6 months (p < 0.001), correlating with increased QOL scores (p < 0.001). Sixteen percent required revision procedures. Complication rates were low, with no procedure-related mortality.

Discussion: Significant improvements in headache, papilledema, and quality of life were observed with a favorable safety profile with venous sinus stenting for medically refractory IIH. However, the retrospective design and lack of a control group limit definitive conclusions about efficacy.