Re-Stenting Following Recurrence after Successful Venous Sinus Stenosis Stenting for Idiopathic Intracranial Hypertension.

Objective: In medically refractory idiopathic intracranial hypertension (IIH), venous sinus stenosis (VSS) stenting has been an effective treatment modality. Among patients who experience recurrent symptoms and develop new stenosis, the optimal treatment strategy is unknown. The aim of this study was to investigate the role of rescue re-stenting in patients with recurrence after prior successful stenting.

Methods: This was a single center, retrospective review from a prospectively maintained IIH registry. Between 2012 and 2023, patients who underwent interventions for confirmed IIH and angiographically demonstrable VSS were included. The cohort was divided into those who underwent a single stenting procedure (single stent group) and those who underwent re-stenting due to recurrence of symptoms and new angiographic stenosis (re-stent group).

Results: Ninety seven patients were included: 87 in the single stent group and 10 in the re-stent group, with a median age of 32 (interquartile range 26-38). 94% were female. Both groups had similar baseline demographic and clinical characteristics. There was similar improvement in papilledema and tinnitus. Headache improvement was greater in the single stent group at 6 weeks (88.4% vs. 60.0%, p = 0.04, single vs. re-stent group), but similar at 6 months post-procedure. For visual disturbances, there was similar improvement at 6 weeks, but greater improvement in the single stent group at 6 months post-procedure (86.8% vs. 75.0%, p = 0.04, single vs. re-stent group). None of the re-stented patients required rescue ventriculoperitoneal shunt placement.

Conclusion: Re-stenting among IIH patients with recurrent symptoms after initial successful VSS stenting is feasible with similar efficacy in improving symptoms.