{
  "abstract": "Background and Objectives Venous sinus stenting (VSS) is an established treatment for medically refractory idiopathic intracranial hypertension (IIH), yet the clinical significance of bilateral trans-stenotic venous pressure gradients and the optimal stenting strategy in this setting remain poorly defined.Methods We retrospectively reviewed prospectively collected data on consecutive IIH patients undergoing VSS at a single institution (2021-2024). Only patients with a trans-stenotic gradient ≥8 mmHg confirmed by venous manometry were included. Primary outcomes included symptom improvement, overall treatment response, and need for repeat VSS.Results Ninety-two patients were included, of whom 44 (48%) demonstrated bilateral venous pressure gradients. Bilateral gradients were more prevalent among Black patients (p = 0.041) but were not associated with differences in lumbar puncture opening pressure, presenting symptoms, or emergent presentation (p ≥ 0.05). Among patients with bilateral gradients, unilateral stenting was associated with lower rates of satisfactory clinical response (23% vs 74%; p=0.002) and higher rates of repeat intervention (62% vs 3.2%; p<0.001) compared with bilateral stenting. Tinnitus resolution was significantly more frequent following bilateral stenting (11% vs 68%; p = 0.005). Clinical outcomes following staged bilateral stenting after failed unilateral treatment were comparable to those achieved with index bilateral stenting.Conclusions Bilateral venous pressure gradients are common in IIH and identify a subgroup in whom unilateral stenting alone may be insufficient. In these cases, upfront bilateral stenting is often needed and associated with superior clinical outcomes.Disclosures V. El-Hajj: None.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA"
      ],
      "name": "V El-Hajj"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA"
      ],
      "name": "M Gharios"
    },
    {
      "affiliations": [
        "Neurosurgery, Thomas Jefferson University, Philadelphia, PA"
      ],
      "name": "J Roy"
    },
    {
      "affiliations": [
        "Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA"
      ],
      "name": "B Musmar"
    },
    {
      "affiliations": [
        "Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA"
      ],
      "name": "S Tjoumakaris"
    },
    {
      "affiliations": [
        "Thomas Jefferson University Hospital, Philadelphia, PA"
      ],
      "name": "M Gooch"
    },
    {
      "affiliations": [
        "Thomas Jefferson University Hospital, Philadelphia, PA"
      ],
      "name": "P Jabbour"
    }
  ],
  "title": "E-233 Treatment of idiopathic intracranial hypertension with bilateral trans-stenotic pressure gradients: unilateral versus bilateral venous sinus stenting",
  "uid": "2665c1dc-82cc-57c9-8df3-375d57999c95"
}